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目的探讨早期足量静脉营养对极低出生体重儿宫外生长及酸碱平衡状态的影响。方法 2010年1月～10月在我院新生儿重症病房住院的存活极低出生体重儿160例,按入院先后顺序将患儿随机分为两组:治疗组80例和对照组80例,治疗组即早期足量静脉营养组,对照组即传统静脉营养组,两组其他治疗均相同,均按需给予电解质、维生素和微量元素,均尽早经口或间断经胃管微量肠道喂养,不能经口喂养者给予非营养性吸吮,肠道内营养热卡达90～100 kCal/(kg.d)时停静脉营养,每天计算热卡,称体重,每天监测多次微量血糖,计算体重下降幅度及恢复出生时体重的平均时间,计算经胃肠达到摄入标准的平均时间,两组患儿出院时EUGR的发生率。各组患儿均于治疗第1d、第4d及第7d留取桡动脉血60μl进行血气分析,记录pH、BE、氧分压、二氧化碳分压、碳酸氢根离子等指标变化。结果治疗组与对照组比较,治疗组极低出生体重儿平均住院时间和生理性体重下降持续时间缩短(P<0.05),体重下降幅度低(P<0.01),每天体重增长快于对照组(P<0.01),过渡到全肠道营养的时间缩短(P<0.01),节约住院费用(P<0.01)。治疗组生后第3天热卡明显高于对照组(P<0.05),出院时EUGR的发生率38.8%低于对照组72.5%(P<0.05)。在治疗的第4d,治疗组的pH值、HCO3-浓度和负离子间隙(BE)均降低(P<0.05),容易发生代谢性酸中毒,体重越低,越容易发生酸碱平衡紊乱(P<0.05)。结论早期足量静脉营养可促进极低出生体重儿的宫外生长,减少极低出生体重儿EUGR的发生率。早期足量静脉营养能够引起代谢性酸中毒发生,早产儿酸碱平衡紊乱主要发生在治疗第四天。早期足量静脉营养可缩短极低出生体重儿的住院时间,每个患儿可节约4000～5000元开支。
Objective To investigate the effect of early adequate parenteral nutrition on extrauterine growth and acid-base balance in very low birth weight infants. Methods From January to October 2010, 160 children with very low birth weight who were hospitalized in the neonatal intensive care unit of our hospital were randomly divided into two groups according to the admission order: 80 cases in the treatment group and 80 cases in the control group. Group that early enough parenteral nutrition group, the control group that is the traditional intravenous nutrition group, the other two groups were the same treatment, were given on demand electrolytes, vitamins and trace elements, as early as possible by oral or intermittent micro-intestinal feeding through the stomach tube can not Oral feeding of non-nutritive sucking, intra-intestinal nutrition hot card 90 ~ 100 kCal / (kg.d), stop the vein nutrition, daily calorie calculation, weighing body weight, blood glucose monitoring several times a day to calculate the weight loss And the average time to restore birth weight, calculate the average time to reach the intake by the gastrointestinal, EUGR incidence of discharge of two groups of children. Blood samples were collected from 60 d of radial arterial blood on the first day, the fourth day and the seventh day of treatment, and the changes of pH, BE, partial pressure of oxygen, partial pressure of carbon dioxide and bicarbonate ion were recorded. Results Compared with the control group, the average length of hospital stay and the duration of physiological weight loss in the treatment group were significantly decreased (P <0.05) and the weight loss rate was lower (P <0.01) in the treatment group than in the control group P <0.01). The time to transition to the whole intestine was shortened (P <0.01), and hospitalization cost was saved (P <0.01). The heat card on the third day after birth in the treatment group was significantly higher than that in the control group (P <0.05). The incidence of EUGR at discharge was 38.8% lower than that of the control group (72.5%, P <0.05). On the 4th day of treatment, the pH value, HCO3- and anion gap (BE) of the treatment group decreased (P <0.05), metabolic acidosis easily occurred, the body weight was lower, the more prone to acid-base balance disorder (P < 0.05). Conclusion Early adequate parenteral nutrition can promote extrauterine growth of very low birth weight infants and reduce the incidence of EUGR in very low birth weight infants. Early adequate intravenous nutrition can cause metabolic acidosis, premature children acid-base balance disorder occurs mainly in the fourth day of treatment. Early adequate intravenous nutrition can shorten the length of hospitalization for very low birth weight children, each child can save 4000-5000 yuan expenditure.