肠外营养方式对极低出生体重儿肝脏功能影响的随机对照研究

目的探讨保守肠外营养与积极肠外营养两种方式对极低出生体重儿(very low birth weight infants,VLBWI)肝脏功能的影响。方法将2008年3月-2013年3月入院的极低出生体重儿随机化分为低肠外营养组75例{(氨基酸及脂肪乳剂量均从0.5~1.0g/(kg·d)起,增量为0.5~1.0g/(kg·d),直至足量3g/(kg·d);葡萄糖开始输注速度均为4mg/(kg·min),每天增加1mg/(kg·min),最高不超过12mg/(kg·min)},高肠外营养组71例{(氨基酸剂量从1.5~2.0g/(kg·d)起,增量为1.0g/(kg·d),直至足量3.5~4g/(kg·d);脂肪乳剂量从1.0g/(kg·d)起,增量为1.0g/(kg·d),直至足量3.0g/(kg·d);葡萄糖开始输注速度均为6mg/(kg·min),然后每天增加2mg/(kg·min),最高不超过12mg/(kg·min)},记录两组的喂养情况、生长指标,并测定肝功能。结果低肠外营养组在肠外营养持续时间、肠内营养达90kCal/(kg·d)日龄及恢复出生体重时间大于高肠外营养组,差异有统计学意义(P0.05)。两组在第7天、第14天及第28~42天主要生化指标测定的差异无统计学意义(P0.05);两组肠外营养相关胆汁淤积(PN-associated cholestasis)发生率的差异无统计学意义(P0.05)。两组住院天数的差异亦无统计学意义(P0.05);两组的住院费用差异有统计学意义(P0.05)。结论高肠外营养方式不会影响VLBWI的肝脏功能,也未增加肠外营养相关胆汁淤积的发生。

Randomized control study of two different parenteral nutrition strategies on liver fuction of very low birth weight infants

Objective To explore the effects of two different parenteral nutrition (PN) treatments (conservative and active) on the liver function of very low birth weight infant (VLBWI). Methods The VLBWIs were randomly divided into low PN (n=75) and high PN groups (n=71) hospitalized from March 2008 to March 2013.The low PN treatment was defined asamino acids and fat emulsion started with a dosage of 0.5~1.0 g/(kg·d), increased 0.5~1.0 g/(kg·d) up to a sufficient amount of 3 g/ (kg·d);glucose infusion rate started from 4 mg/(kg·min), increased 1 mg/(kg·min) per day, up to a maximum of 12 mg/(kg·min).The high PN group was defined asamino acid started from 1.5~2.0 g/(kg·d) then increased 1.0 g/(kg·d) up to a sufficient amount of 3.5~4.0 g/(kg·d), fat emulsion started from 1.0 g/(kg·d) then increased 1.0 g/(kg·d) up to a sufficient amount of 3.0 g/(kg·d) and glucose infusion rate started from 6 mg/(kg·min) then increased 2 mg/(kg·min) per day up to a maximum of 12 mg/(kg·min).The enteral feeding and growth index were recorded.Liver function was measured. Results Compared with high PN group, the PN duration in low PN group lasted longer, the time for calorie of enteral feeding to reach 90 kcal/(kg·d) and the time for birth weight catch-up were longer in low PN group (P<0.05).The primary biochemical markers of 7^th, 14^th and 28^th~42^th day were similar in the two groups (P＞0.05).No statistically significant difference was observed in the incidence of PN-associated cholestasis(PNAC) between the two groups (P＜0.05).The hospitalization days were similar in the two groups (P＞0.05).The hospitalization fee in the high PN group was less than that in the low PN group (P＜0.05). Conclusion High PN do not affect the liver function or increase the incidence of PNAC in VLBWI.