氨基酸初始大剂量与快速增加方案对早产儿生长发育的影响

摘要

目的：探讨氨基酸初始大剂量与快速增加方案对早产儿生长发育的影响及安全性。方法：将86例早产儿根据出生24 h内氨基酸静脉滴注方案分为A组（46例）和B组（40例）。A组患儿给予氨基酸初始大剂量2.4 g/kg，以0.5 g/（kg·d）递增；B组患儿给予氨基酸快速增加方案，初始剂量为1.5 g/kg，以1.0 g/（kg·d）递增，两组患儿终点剂量均为3.6 g/（kg·d）。比较两组患儿治疗后生长发育指标，静脉营养、住新生儿重症监护病房（NICU）及住院天数，治疗费用、治疗1、7 d的前白蛋白（PA）、胃功素（MOT）及血浆血管活性肠肽（VIP）水平、治疗1周内氮平衡值，并记录喂养不耐受性及并发症发生率。结果：治疗后，两组患儿周平均身长增加值、周平均头围增加值比较，差异无统计学意义（P＞0.05）。A组患儿恢复至出生体质量的时间，住NICU、静脉营养及住院天数与住院费用均短于或少于B组，差异均有统计学意义（P＜0.05）。两组患儿治疗后1、7 d PA水平比较，差异无统计学意义（P＞0.05）；两组患儿治疗后7 d MOT和VIP均显著升高，且A组显著高于B组，差异均有统计学意义（P＜0.05）。A组患儿1周内氮平衡值均优于B组，差异有统计学意义（P＜0.05）。A组患儿喂养不耐受率为4.35％，显著低于B组的20.00％，差异有统计学意义（P＜0.05）。两组患儿并发症发生率比较，差异无统计学意义（P＞0.05）。结论：与快速增加方案相比，氨基酸初始大剂量方案可增加喂养耐受性，改善营养状况，缩短住院时间，减少治疗费用，且安全性较好。%OBJECTIVE:To explore the effects and safety of initial high-dose and rapid increase regimen of amino acids on growth and development of premature infants. METHODS:86 cases of preterm infants were divided into group A(46 cases)and B (40 cases) according to the intravenous infusion regimen of amino acids in 24 h after birth. Group A was given amino acids with initial high-dose of 2.4 g/kg,increasing by 0.5 g/(kg·d)progressively;group B was given rapid increase regimen of amino acids with initial dose of 1.5 g/kg,increasing by 1.0 g/(kg·d) progressively. The terminal dose of 2 groups was 3.6 g/(kg·d). The growth and development index,were compared between 2 groups after treatment as well as intravenous nutrition,the length of NI-CU and hospital stay,treatment cost and the levels of prealbumin (PA),motlin (MOT) and plasma vasoactive intestinal peptide (VIP),nitrogen balance index within one week of treatment. Feeding intolerance and the incidence of complications were recorded in 2 groups. RESULTS:There was no statistical significance in the increase of average height and head circumference in 1 week be-tween 2 groups(P>0.05). The time of returning to birth weight,length of stay in NICU,duration of intravenous nutrition,length and costs of hospital stay in group A was shorter or less than group B,with statistical significance(P<0.05). There was no statisti-cal significance in PA level between 2 groups in 1,7 d after treatment(P>0.05);MOT and VIP of group A were increased signifi-cantly and higher than those of group B,with statistical significance (P<0.05). The nitrogen balance of group A was better than that of group B within 1 week,with statistical significance (P<0.05). The incidence of feeding intolerance in group A was 4.35%,which was significantly lower than in group B (20.0%),with statistical significance (P<0.05). There was no statistical significance in the incidence of complications between 2 groups (P>0.05). CONCLUSIONS:Compared with rapid increase regi-men,initial high-dose regimen of amino acids can enhance feeding tolerance,improve the nutritional status,shorten the length of hospital stay reduce the cost of treatmend with good safety.