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目的探讨早期胃肠外营养方案对超低出生体重儿(ELBWI)出生72h内电解质的影响。方法回顾性分析我院2010—2011年收治的ELBWI的胃肠外营养方案,根据营养方案不同分为早期胃肠外营养组(EPN组)和延迟胃肠外营养组(LPN组),EPN组生后4h内开始予以6.7%小儿氨基酸1.6g/(kg·d),1g/(kg·d)递增,10%葡萄糖酸钙1mmol/100ml,24h内开始予以20%脂肪乳1g/(kg·d),1g/(kg·d)递增;LPN组出生8～24h开始予以6.7%小儿氨基酸0.5g/(kg·d),0.5g/(kg·d)递增,20%脂肪乳0.5g/(kg·d),0.5g/(kg·d)递增,根据血钙水平决定是否补钙。分别于出生后24、48h及72h检测血清钾、钠、游离钙水平,记录每日液体摄入量、尿量及死亡例数等。结果与EPN组相比,LPN组72h内高钾血症、低钙血症发生率均增加(33.3%比3.6%,80.0%比10.7%,P均<0.05),两组胎龄、出生体重、性别、分娩方式、产前激素使用、每日液体入量、血气pH值、血糖等差异均无统计学意义(P>0.05)。结论对ELBWI早期予氨基酸、钙剂以及24h内开始脂肪乳可减少早期电解质紊乱,尤其减少早期非少尿性高钾血症,可以预防致命性高血钾的发生。
Objective To investigate the effect of early parenteral nutrition on electrolytes during the first 72 hours of ELBWI. Methods Retrospective analysis of the ELBWI parenteral nutrition program in our hospital from 2010 to 2011 was divided into two groups: the early parenteral nutrition group (EPN group) and the delayed parenteral nutrition group (LPN group), the EPN group 6.7% pediatric amino acids 1.6g / (kg · d), 1g / (kg · d) increments and 10% calcium gluconate 1mmol / 100ml were taken within 4 hours after birth, and 20% fat emulsion 1g / (kg · d) and 1g / (kg · d) respectively. In the LPN group, 6.7% of children were given amino acid 0.5g / (kg · d), 0.5g / (kg · d) (kg · d), 0.5g / (kg · d) increase, according to the level of calcium to determine whether calcium. Serum potassium, sodium and free calcium levels were measured at 24, 48h and 72h after birth respectively. Daily fluid intake, urine output, number of deaths and so on were recorded. Results Compared with EPN group, the incidence of hyperkalemia and hypocalcemia in LPN group increased in 72 h (33.3% vs. 3.6%, 80.0% vs 10.7%, P <0.05). The gestational age, birth weight Sex, mode of delivery, prenatal hormone use, daily fluid intake, blood gas pH, blood glucose and other differences were not statistically significant (P> 0.05). Conclusion Early ELBWI administration of amino acids and calcium and fat emulsion started within 24 hours can reduce the early electrolyte imbalance, especially the reduction of early non-oliguric hyperkalemia, which can prevent the occurrence of fatal hyperkalemia.