目的 探讨早期一定量静脉营养和既往较晚少量肠外营养对早产儿生长发育的影响。 方法 将168例早产儿按入院时间随机分为治疗组86例,对照组82例。治疗组给予早期定量肠外营养支持,第1天给予氨基酸1 g/(kg·d),以后按1 g/(kg·d)的速度增加,增加至3.5 g/(kg·d);脂肪乳第1天用量1 g/(kg·d),以后按1 g/(kg·d)的速度增加,增加至3.5 g/(kg·d)。对照组按传统肠外营养较晚给予少量营养支持,出生后第3天开始给予氨基酸和脂肪乳各0.5 g/(kg·d),以后按0.5 g/(kg·d) 的速度增加,增加至3.5 g/(kg·d)为止。观察早产儿体重变化、住院天数和宫外生长发育迟缓的临床资料以及血糖、电解质、血脂、胆红素、胆汁酸和肝肾功等生化检测结果。 结果 与对照组相比,治疗组生理性体重下降时间和恢复时间明显缩短,体重日增长量明显增多,住院天数减少,宫外生长发育的发生率明显降低;治疗组电解质紊乱和低血糖的发生率低于对照组,高血糖和低血钙的发生率明显高于对照组(P<0.01);治疗组血清前蛋白、白蛋白、球蛋白、血尿素氮和血脂水平明显高于对照组,两组间总胆红素、胆汁酸和肝功能差异无明显统计学意义(P>0.05)。 结论 早期定量肠外营养能有效促进早产儿生长发育,临床应用较为安全,但尚未达到理想的营养状态,还需进一步研究完善。

Objective To approach effects of different parenteral nutrition strategies on growth and development of premature infants. Methods A total of 168 premature infants were divided into two groups randomly.The infants in the treat group were given early and sufficient parenteral nutrition (PN),and those in the control group were given traditional PN.The body weight,hospital day and extrauterine growth restriction (EUGR) were recorded as well as blood glucose,blood electrolytes,blood lipid,bilirubin,bile acid,hepatic function and renal function. Results Compared to the control group,daily growth increments of body weight were significantly enhanced in the treat group,and the infants' body weight in the treat group recovered much more quickly than that in the control group.Besides,the length of hospital stay and the rate of EUGR were decreased in the treat group.The incidences of blood potassium,sodium and chloride disorder,and hypoglycemia in the control group were higher than those in the treat group,but the incidences of hyperglycemia and hypocalcemia in the treat group were higher than those in the control group(P<0.01).The levels of serum preprotein,albumin,globulin,blood lipid and blood urea nitrogen levels in the treat group were higher than those in the control group.There were no significant differences in the levels of bilirubin,bile acid and hepatic function between two groups(P>0.05). Conclusion Early and certain PN could promote growth and development of premature infants which may provide a safe strategy in PN of premature infants.