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目的探讨保守肠外营养与积极肠外营养两种方式对极低出生体重儿(very low birth weight infants,VLBWI)肝脏功能的影响。方法将2008年3月-2013年3月入院的极低出生体重儿随机化分为低肠外营养组75例{(氨基酸及脂肪乳剂量均从0.5~1.0g/(kg·d)起,增量为0.5~1.0g/(kg·d),直至足量3g/(kg·d);葡萄糖开始输注速度均为4mg/(kg·min),每天增加1mg/(kg·min),最高不超过12mg/(kg·min)},高肠外营养组71例{(氨基酸剂量从1.5~2.0g/(kg·d)起,增量为1.0g/(kg·d),直至足量3.5~4g/(kg·d);脂肪乳剂量从1.0g/(kg·d)起,增量为1.0g/(kg·d),直至足量3.0g/(kg·d);葡萄糖开始输注速度均为6mg/(kg·min),然后每天增加2mg/(kg·min),最高不超过12mg/(kg·min)},记录两组的喂养情况、生长指标,并测定肝功能。结果低肠外营养组在肠外营养持续时间、肠内营养达90kCal/(kg·d)日龄及恢复出生体重时间大于高肠外营养组,差异有统计学意义(P<0.05)。两组在第7天、第14天及第28~42天主要生化指标测定的差异无统计学意义(P>0.05);两组肠外营养相关胆汁淤积(PN-associated cholestasis)发生率的差异无统计学意义(P>0.05)。两组住院天数的差异亦无统计学意义(P>0.05);两组的住院费用差异有统计学意义(P<0.05)。结论高肠外营养方式不会影响VLBWI的肝脏功能,也未增加肠外营养相关胆汁淤积的发生。
Objective To investigate the effects of conservative parenteral nutrition and active parenteral nutrition on the liver function of very low birth weight infants (VLBWI). Methods The children with very low birth weight who were hospitalized from March 2008 to March 2013 were randomly divided into 75 cases with low parenteral nutrition group (amino acids and lipid emulsions were all from 0.5 to 1.0 g / (kg · d) (Kg · d) until the dose was 3g / (kg · d), the initial infusion rate of glucose was 4mg / (kg · min), and the dose of glucose increased 1mg / (kg · min) (No more than 12 mg / (kg · min)}, and 71 patients in the high-enteral nutrition group (the dose of amino acids increased from 1.5 to 2.0 g / (kg · d) in 1.0 g / (kg · d) Kg · d), and the dosage of fat emulsion increased from 1.0g / (kg · d) to 1.0g / (kg · d) until the dosage reached 3.0g / (kg · d) The initial infusion rate was 6mg / (kg · min), then increased 2mg / (kg · min) every day, the maximum does not exceed 12mg / (kg · min)}. The feeding status and growth index were recorded and the liver Function.Results In the parenteral nutrition group, the parenteral nutrition duration, enteral nutrition up to 90kCal / (kg · d) day and the weight gain time were higher than those in the high parenteral nutrition group (P <0.05) There was no significant difference in the main biochemical indexes between the two groups on the 7th, the 14th and the 28th to the 42nd (P> 0.05) .The PN-associat (P> 0.05). There was also no significant difference in the days of hospitalization between two groups (P> 0.05). There was significant difference in hospitalization costs between the two groups (P <0.05). Conclusion High parenteral nutrition does not affect the liver function of VLBWI nor does it increase the occurrence of parenteral nutrition-related cholestasis.