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目的:研究极低出生体重儿(VLBW)对早期全静脉营养耐受情况和近期疗效。方法:将32例极低出生体重儿随机分为2组:延迟全静脉营养组(LTPN)和早期全静脉营养组(ETPN);LTPN组生后24h内只予5%～10%葡萄糖,第2天加6%小儿氨基酸,72h后加脂肪乳;氨基酸从1.0g/(kg·d)开始,每日递增0.5g/(kg·d),直至3.5g/(kg·d);脂肪乳选用20%中长链脂肪酸,从0.5g/(kg·d)开始每日递增0.5g/(kg·d),直至3.0g/(kg·d)。ETPN组于生后24h内即予6%小儿氨基酸3.5g/(kg·d)和脂肪乳3.0g/(kg·d)。动态检测1周内血脂、血清胆红素、肾功能、血碳酸氢盐、血糖等生化指标,并记录体重最大丢失、恢复出生体重时间和达到完全胃肠营养时间等指标。结果:与LTPN组相比,ETPN组体重丢失较少,恢复出生体重时间和实施完全胃肠营养时间缩短,血清前白蛋白水平增加,而代谢性酸中毒、脂质代谢紊乱、高胆红素血症以及肾功能损伤等代谢并发症无显著差异,其它合并症也无显著差异。结论:极低出生体重儿可以耐受早期全静脉营养,且早期全静脉营养对VLBW新生儿有一定的临床效果。
Objective: To study the nutritional tolerance and short-term curative effect of very low birth weight infants (VLBW) on early whole veins. Methods: 32 cases of very low birth weight children were randomly divided into two groups: delayed intravenous nutrition group (LTPN) and early total intravenous nutrition group (ETPN); LTPN group within 24h after birth only 5% to 10% glucose, 2 days plus 6% pediatric amino acids, and fat emulsion after 72 hours. The amino acids increased 0.5g / (kg · d) daily from 1.0g / (kg · d) to 3.5g / (kg · d) Choose 20% of medium-long-chain fatty acids, increasing 0.5g / (kg · d) daily from 0.5g / (kg · d) until 3.0g / (kg · d). ETPN group gave 6% pediatric amino acid 3.5g / (kg · d) and fat emulsion 3.0g / (kg · d) within 24h after birth. Dynamic detection of blood lipid, serum bilirubin, renal function, blood bicarbonate, blood glucose and other biochemical indicators within 1 week, and recorded the maximum weight loss, weight gain recovery time and complete gastrointestinal nutrition time and other indicators. Results: Compared with the LTPN group, the body weight lost less, the birth weight time was restored and the time of complete gastrointestinal nutrition was shortened, the level of serum prealbumin increased, while the metabolic acidosis, dyslipidemia, hyperbilirubin There were no significant differences in metabolic complications such as hyperlipidemia and renal dysfunction, and no significant differences in other comorbidities. Conclusion: Very low birth weight infants can tolerate early total parenteral nutrition, and early total parenteral nutrition has certain clinical effect on neonatal VLBW.