早期输注大剂量氨基酸对改善早产儿氮平衡的有效性研究

摘要

Objective To evaluate the efficacy of parenteral nutrition with high-dose amino acids in improving nitrogen balance of premature infants. Methods Premature infants (birth weight 1 000 ~ 2 000 g) recruited into the study were randomized divided into two groups. Trials group (TP) : 2.0 g/(kg·d) of amino acid IV within 24 hours after birth, increasing by increments of 0.85 g/(kg·d) to a maximum of 3.7 g/(kg·d) ; Control group (CP) : 0.5 g/ (kg·d) of amino acid IV within 24 hours after birth, increasing by increments of 0.5 g/(kg·d) to a maximum of 3.7 g/(kg·d). Results TP group showed positive nitrogen balance every day; CP group showed negative nitrogen balance during the first three days, mean nitrogen balance was significantly higher in TP group than in CP group (P < 0.01). TP group showed significantly less weight loss (P < 0.05) , more head circumference gain, quicker growth, shorter day length to tolerate 418.4 kJ/(kg·d) enteral nutrition, shorter day length to regain birth weight and reach 2 000 g than in CP group (all P < 0.05). Conclusions Early administration of intravenous amino acids[2.0 g/(kg·d)] significantly improves nitrogen balance, growth and tolerance of enteral feeding in premature infants.%目的 评价早期输注大剂量氨基酸对改善早产儿氮平衡的有效性.方法 将2010年1月-2010年12月间出生24 h内体质量1000～2000 g入住新生儿重症监护室(NICU)接受肠道外营养治疗的早产儿,随机分为两组.实验组于生后24 h内输注氨基酸2.0 g/(kg·d)起.每天增加0.85 s/ks.预期峰值3.7 g/(kg·d);对照组于出生24 h内输注氨基酸0.5g/(kg·d)起,每天增加0.5 g/ks,预期峰值3.7 g/(kg·d).结果 实验组早产儿生后第1周均处于正氮平衡;对照组早产儿生后前3 d均处于负氮平衡;实验组早产儿第1周每天平均氮平衡值均大于对照组,差异有统计学意义(P均<0.01).实验组早产儿体质量下降百分比少于对照组,差异有统计学意义(P<0.05);头围增长大于对照组,差异有统计学意义(P<0.05);达到肠内营养418.4 kJ/kg的天数、恢复出生体质量的天数和体质量达到2 000 g的天数均少于对照组,差异有统计学意义(P均<0.05).结论 早产儿生后24 h内即开始输注大剂量氨基酸(2.0 g/kg)能显著改善氮平衡,增加喂养耐受性和促进早产儿生长.