目的 了解快速增加氨基酸剂量对早产儿的影响,评价其有效性及安全性,探讨合理的早产儿氨基酸应用方案.方法 2011年11月至2013年1月出生体重1 000～1 800g、出生24 h内入住本院的早产儿,根据随机数字表法分为研究组和对照组.两组患儿均在出生后24 h内开始静脉营养,氨基酸起始剂量均为1.5g/(kg·d),研究组每天增加1g/kg,对照组每天增加0.5g/kg,终点目标达到3.5g/(kg·d).脂肪乳、葡萄糖及电解质的应用均按本院静脉营养方案执行.研究遵循双盲原则.结果 共纳入早产儿37例,研究组18例,对照组19例.两组早产儿的胎龄、出生体重、头围等人口学特征相似,宫内感染、窒息、新生儿呼吸窘迫综合征等合并症差异无统计学意义(P＞0.05).接受静脉营养5d内两组早产儿氮平衡状态差异无统计学意义(F =0.025,P=0.652),但研究组恢复出生体重的时间(7.23 ±2.48)d显著早于对照组(9.42 ±2.03)d(t=-2.090、P=0.044).其他指标包括完全喂养的时间、体重增长速度、头围增长速度、平均住院日、住院费用两组比较差异无统计学意义(P＞0.05),常见并发症包括新生儿坏死性小肠结肠炎、败血症、机械通气、肝肾功能异常发生率两组比较差异无统计学意义(P＞0.05).接受不同剂量氨基酸对研究组和对照组早产儿每天的热量摄入无影响(F=1.893,P=0.218).结论 早产儿需尽早供给氨基酸,起始剂量宜高于1.5g/(kg·d),快速增加氨基酸剂量未影响早产儿早期的氮平衡状态,但有助于早产儿体重增长,且不增加并发症和住院负担.%Objective To explore the influence of early rapidly increased amino acid dosaging on the nitrogen balance and growth in preterm infants.Methods A total of 37 prematures admitted to our NICU within 24 hours after birth and with birth weight of 1 000 g to 1 800 g from November 2011 to January 2013 were randomly divided into study group (n =18) and control group (n =19).Parenteral nutrition (PE) was provided in both groups within 24 hours after birth.The starting amino acid dose was 1.5g/kg per day,then rose by 1 g/kg per day in study group and by 0.5 g/kg per day in control group,until to maximum of 3.5 g/kg per day.The dosage of lipids,glucose,and electrolytes in parenteral nutrition was provided routinely.The trial was double-blinded.Results In the first 5 days of PE,the nitrogen balance had no significant difference between these two groups (F =0.025,P =0.652) ; however,the time of regaining birth weight was significantly shorter in study group [(7.23±2.48) d] than in control group [(9.42±2.03) d] (t=-2.090,P=0.044).There were no differences between these two groups in trems of completely feeding time,weight gain rate,head circumference growth rate,length of hospital stay,and hospital costs (all P ＞ 0.05).Meanwhile,the rates of neonatal necrotizing enterocolitis,sepsis,mechanical ventilation administration,and damage of hepatic and renal function were also not significantly different.The administration of different dosages of amino acids did not affect the energy intake in both groups (F =1.893,P =0.218).Conclusions Prematures need early amino acid administration,with a starting dosage of more than 1.5 g/(kg · d).Rapid increase of amino acid dosing will not affect early nitrogen balance in premature infants; meanwhile,it contributes to weight gain without increasing the complications and hospitalization costs.
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