高剂量脂肪乳剂对极低出生体质量儿钙、磷及碱性磷酸酶的影响

目的 探讨较高剂量豆油基20％中/长链脂肪乳剂对极低出生体质量儿血清钙、磷及碱性磷酸酶的影响. 方法 采用前瞻性随机对照研究方法,选择88例胎龄27～32周的适于胎龄极低出生体质量儿,随机分为2组:研究组生后24 h内给予20％脂肪乳剂2.0 g/kg,每日增加0.5～1 g·kg-1·d-1,直至3.5 g· kg-1·d-1;对照组生后24 h后开始给予20％脂肪乳剂0.5 g/kg,每日增加0.5 g·kg-1·d-1,直至3.5 g·kg-1·d-1;2组均于24 h内给予氨基酸2 g· kg-1·d-1,每日增加0.5～1.0 g· kg-1· d-1,直至3.5 g· kg-1· d-1.糖浓度由10％逐渐增加至12.5％.分别在生后4 h及生后4,10,17,24及39 d抽血检测血清钙、磷、碱性磷酸酶. 结果 2组在男女比例、胎龄、出生体质量、禁食时间、开奶时间、补充维生素AD开始时间、补磷时间、补磷开始时间比较,差别均无统计学意义(P>0.05).研究组生后17 d血磷浓度[(1.81±0.29) mmol/L]明显高于对照组[(1.56±0.54) mmol/L](P<0.05);生后10,17及24 d的碱性磷酸酶[(232.0±83.2),(301.3±96.6),(284.1±78.8)U/L]显著低于对照组[(298.6±80.9),(385.5±157.3),(349.2±111.8) U/L](P<0.05). 结论 早期积极地给予较高剂量的脂肪乳剂对于代谢性骨病可能具有一定的保护作用.

Influences of Higher Amounts of Intravenous Fat Emulsion on Serum Calcium,Phosphorus and Alkaline Phosphatase Level of Very Low Birth Weight Infants

Objective To evaluate the impact of application of higher amounts of intravenous 20％ soybean medium and long chain fat emulsion on serum calcium,phosphorus, and alkaline phosphatase levels of very low birth weight infants.Methods The prospective study included 88 cases of very low birth weight infants whose fetal ages were 27～32 weeks.They were randomly divided into intervention group (group A) and control group (group B).The intervention group received infusion of the medium and long chain fat emulsion at 2.0 g·kg-1·d-1 in the first 24 hours after birth with daily increment of 0.5～1 g·kg-1·d-1 up to 3.5 g·kg-1·d-1.The control group received infusion of the medium and long chain fat emulsion at 0.5 g·kg-1·d-1 in the first 24 hours after birth with daily increment of 0.5 g·kg-1·d-1 up to 3.5 g·kg-1·d-1.Both groups received infusion of amino acids at 2 g·kg-1·d-1 with daily increment of 0.5～1 g·kg-1·d-1 up to 3.5 g·kg-1·d-1 and glucose concentration at 10％ with piecemeal increment up to 12.5％.Serum calcium,phosphorus, and alkaline phosphatase were measured and compared between the two groups at birth hour 4, day 4,day 10, day 17, day 24, and day 39 after birth.Results With no significant difference in male female ratio, fetal age, birth weight, absolute diet time, milk feeding initiation time, vitamin AD supply initiation time, phosphorus duration, phosphorus supply initiation time between group A and group B, the level of serum phosphorus in group A (1.81±0.29) mmol/L at day 17 after birth was significantly higher than that in group B (1.56±0.54) mmol/L(P<0.05).However the level of serum alkaline phosphatase in group A [(232.0±83.2), (301.3±96.6), (284.1±78.8) U/L] at day 10, day 17, and day 24 after birth, were significantly lower than that in group B[(298.6±80.9), (385.5±157.3),(349.2±111.8) U/L](P<0.05).Conclusions Active intravenous fat emulsions (IVFEs) during the first week of life may provide protection against metabolic bone disease.