积极肠外营养支持方案在胎龄<34 周早产儿中的应用

目的探讨积极肠外营养支持方案(高初始剂量氨基酸和脂肪乳)在胎龄<34周早产儿肠外营养中的近期疗效及耐受情况。方法根据早期应用氨基酸和脂肪乳剂量不同,将2019年5月至2019年12月收治,生后24小时内入院、胎龄<34周138例早产儿随机分2组。积极肠外营养组69例,氨基酸自2.5 g/(kg·d)始,逐日增加1.0 g/(kg·d),达4 g/(kg·d)并维持;脂肪乳自2.0 g/(kg·d)始,逐日增加0.5~1.0 g/(kg·d),达3.5 g/(kg·d)并维持。常规肠外营养组69例,氨基酸自2 g/(kg·d)始,逐日增加0.5 g/(kg·d),总量不超过4 g/(kg·d)。脂肪乳自1 g/(kg·d)始,总量不超过3 g/(kg·d)并维持。同时实施常规的其他肠内外营养支持方案。结果积极肠外营养组早产儿生后第1、2、3周体质量增长值均高于常规肠外营养组,肠外营养时间、达到全肠道喂养日龄短于常规肠外营养组,差异均有统计学意义(P<0.05)。积极肠外营养组乳糖不耐受和呼吸暂停比例低于常规肠外营养组,差异均有统计学意义(P<0.05)。两组患儿仅血尿素氮水平在生后24小时和谷氨酸氨基转移酶在第2周的差异有统计学意义(P<0.05),积极肠外营养组低于常规肠外营养组。结论胎龄<34周早产儿在生后24小时内同时给予高剂量氨基酸与脂肪乳的积极肠外营养安全有效,可显著减少肠外营养使用时间并促进近期体质量增长,且未增加并发症。

The effect of active parenteral nutrition support protocol in premature infants with gestational age<34 weeks

Objective To explore the short-term efficacy and tolerance of active parenteral nutrition support protocol(high initial dose of amino acids and fat emulsion)in preterm infants with gestational age<34 weeks.Methods A total of 138 preterm infants with gestational age<34 weeks who were admitted to hospital within 24 hours after birth from May 2019 to December 2019 were randomly divided into two groups according to different amounts of amino acids and fat emulsions applied in the early period.In the active parenteral nutrition group(n=69),the dosage of amino acids started from 2.5 g/(kg·d),increased by 1.0 g/(kg·d)daily,and maintained after reaching 4 g/(kg·d);the dosage of fat emulsion started from 2.0 g/(kg·d),increased by 0.5~1.0 g/(kg·d)daily,and maintained after reaching 3.5 g/(kg·d).In the routine parenteral nutrition group(n=69),the dosage of amino acids started from 2 g/(kg·d),increased by 0.5 g/(kg·d)daily,and the final dosage was no more than 4 g/(kg·d);the dosage of fat emulsion started from 1 g/(kg·d)with final dosage≤3 g/(kg·d),and this final dosage was maintained.Other routine enteral and parenteral nutrition support programs were implemented at the same time.Results The weight gains of preterm infants in the active parenteral nutrition group were higher than those in the routine parenteral nutrition group in the 1,2 and 3 weeks after birth,and the parenteral nutrition time and the days used to achieve total enteral feeding were shorter than those in the routine parenteral nutrition group.All the differences were statistically significant(all P<0.05).The rates of lactose intolerance and apnea in the active parenteral nutrition group were lower than those in the routine parenteral nutrition group,with statistical significance(P<0.05).Only the blood urea nitrogen level at 24 hours postnatal and glutanine aminotransferase level at 2 weeks postnatal had statistically significant differences between the two groups(P<0.05).The above indexes in the active parenteral nutrition group were lower than those in the routine parenteral nutrition group.Conclusion It is safe and effective to give active parenteral nutrition support(high dose of amino acids and fat emulsion)within 24 hours after birth to preterm infants with gestational age<34 weeks,It can significantly reduce the duration of parenteral nutrition and promote the short-term weight gain without increasing complications.