目的 探讨静脉使用不同剂量氨基酸对早产儿早期营养的影响。方法 将接受静脉营养的146例早产儿(胎龄29~34周,出生体重1 150~2 250 g)随机分为3组,大剂量组于生后24 h内给予氨基酸2.0 g/(kg·d),每日递增1.0 g/(kg·d);中剂量组给予氨基酸1.0 g/(kg·d),每日递增0.5 g/(kg·d);小剂量组给予氨基酸0.5 g/(kg·d),每日递增0.5 g/(kg·d);三组最大剂量均为3.5 g/(kg·d)。对三组患儿进行有效性评估和生化、血气指标检测比较。结果 三组结果比较,其中大剂量组恢复至出生体重的时间最短;出生2周内大剂量组每天体重增长速度最快;大剂量组肠道营养达到100 kCal/kg天数较中剂量组和小剂量组短。差异有统计学意义(P＜0.05)。三组早产儿第14天时肾功能尿素氮、肌酐、pH值、剩余碱、血清直接胆红素和总胆汁酸水平比较,各组间差异均无统计学意义(P>0.05)。结论 早期应用大剂量氨基酸更有利于早产儿的营养和生长发育,并且不会增加代谢性酸中毒、肾功能损害、胆汁淤积症等不良后果的发生。

Objective To assess the effectiveness of early different doses of intravenous amino acid supplementation in preterm infants. Methods According different intravenous amino acid administration,one hundred and forty-six preterm infants (fetal age 29~34,birth weight 1 150~2 250 g) were randomly divided into low dose,median dose,high dose groups.The infants in high dose group were treated with amino acid 2.0 g/(kg·d) within 24 hours,increasing by 1.0 g per day;The median dose group was treated with amino acid 1.0g/(kg·d),increasing by 0.5 g per day;The low dose group was treated with amino acid 0.5 g/(kg·d),increasing by 0.5 g per day. Results The time of rebounding to birth weigh in the high dose group was less than that in the median and low dose group;In two weeks after birth,the rate of weight again in the high dose group was highest than that in other dose groups;In the high dose group,time of achieving enteral nutrition of 100 kCal/kg days was lower than that in other dose groups (P<0.05).On the fourteenth day after birth,there was no significant difference in urea nitrogen,creatinine,PH value,base excess,serum bilirubin and total bile acid among the three groups (P>0.05). Conclusion Early higher doses of amino acid supplementation is beneficial to preterm infants' early growth and nutrition with little incidence of metabolic acidosis,renal dysfunction or cholestasis.