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目的研究早期不同热卡摄入对早产儿暂时性高氨血症的影响,以探讨早产儿暂时性高氨血症与热卡摄入的相关性,为制定更为合理的营养支持策略提供指导。方法对200例符合筛查条件的危重早产儿进行血氨监测,随机分为4组,每组50例。第1d总热卡供应量第1组为20~30Kcal/kg·d,第2组为30~40Kcal/kg·d,第3组为40~50Kcal/kg·d,第4组为50~60Kcal/kg·d,热卡每日递增15Kcal/kg·d,目标值为110~120Kcal/kg·d。经过1~10d治疗后,比较4组患儿暂时性高氨血症发生率、出现血氨异常时的血氨值、高氨血症持续时间及中枢神经系统相关并发症的发生率。结果 1~4组早产儿发生暂时性高氨血症的发生率分别为83.67%、62.50%、36.00%和29.16%,差异有统计学意义(χ2=35.93,P<0.01),4组患儿高血氨持续时间及神经系统并发症发生率差异均有统计学意义(P<0.05)。结论早产儿暂时性高氨血症与早期热卡摄入剂量有关。早期适当提高热卡供给可有效减少早产儿暂时性高氨血症发生,并使神经系统并发症的发生率降低。
Objective To study the effect of early different calorie intake on transient hyperammonemia in preterm infants to explore the relationship between temporary hyperammonemia and caloric intake in preterm infants and to provide guidance for making more reasonable nutritional support strategies . Methods Blood ammonia monitoring was performed in 200 cases of critically ill preterm infants who met the screening criteria and were randomly divided into 4 groups of 50 cases. The first day total calorie supply was 20 ~ 30Kcal / kg · d in the first group, 30 ~ 40Kcal / kg · d in the second group, 40 ~ 50Kcal / kg · d in the third group, and 50 ~ 60Kcal in the fourth group / kg · d, heat card daily increase of 15Kcal / kg · d, the target value of 110 ~ 120Kcal / kg · d. After 1 to 10 days of treatment, the incidence of transient hyperammonemia, blood ammonia levels, duration of hyperammonemia and CNS-related complications in the four groups were compared. Results The incidence of transient hyperaemnia in preterm infants of 1 ~ 4 group was 83.67%, 62.50%, 36.00% and 29.16%, respectively, with statistical significance (χ2 = 35.93, P <0.01) There were significant differences in the duration of high blood ammonia and the incidence of neurological complications (P <0.05). Conclusions Temporary hyperammonemia in preterm infants is related to the dose of early calorie intake. Proper early heat card supply can effectively reduce the incidence of transient hyperammonemia in preterm infants and reduce the incidence of neurological complications.