多种油脂肪乳在超低出生体重儿中应用的疗效分析

Clinical effect of multi-oil fat emulsion for parenteral nutrition support in extremely low birth weight infants

摘要:

目的 分析多种油脂肪乳（SMOF）在超低出生体重（ELBW）儿中应用的疗效。方法 回顾性选取2018年1月1日至2020年7月30日收治的ELBW儿49例为研究对象，入院时日龄≤14 d，接受胃肠外营养时间 > 14 d。根据应用的脂肪乳剂种类，分为SMOF组（n=26）和中长链脂肪乳（MCT/LCT）组（n=23），比较两组患儿间临床特征、并发症发生情况、营养支持治疗及相关结局。结果 49例患儿平均出生体重为（892±83）g，平均出生胎龄为（28.2±2.3）周。两组间血流动力学意义的动脉导管未闭、脑室内出血、新生儿坏死性小肠结肠炎、早产儿视网膜病变、支气管肺发育不良（BPD）、BPD Ⅲ度、败血症、肺炎等并发症发生率比较差异均无统计学意义（P > 0.05）。两组间胃肠外营养应用时间、达全肠内营养日龄及出院时头围、身长、体重等比较差异均无统计学意义（P > 0.05）。共有22例（45%）患儿发生胃肠外营养相关性胆汁淤积症（PNAC），其中SMOF组13例（50%），MCT/LCT组9例（39%），两组间比较差异无统计学意义（P > 0.05）；但SMOF组PNAC患儿的直接胆红素及谷氨酸氨基转移酶峰值均低于MCT/LCT组（P < 0.05）。结论 ELBW儿应用SMOF没有降低相关并发症的发生率；但和应用MCT/LCT比较，SMOF能减轻ELBW儿发生PNAC的严重程度。

Abstract:

Objective To study the clinical effect of multi-oil fat emulsion for parenteral nutrition support in extremely low birth weight (ELBW) infants. Methods A retrospective analysis was performed for 49 ELBW infants who were admitted from January 1, 2018 to July 30, 2020, with an age of ≤14 days on admission and a duration of parenteral nutrition of > 14 days. According to the type of lipid emulsion received, the ELBW infants were divided into two groups: soybean oil, medium-chain triglycerides, olive oil, and fish oil (SMOF) (n=26) and medium-chain triglycerides/long-chain triglycerides (MCT/LCT) (n=23). The two groups were compared in terms of clinical features, complications, nutrition support therapy, and outcome. Results The 49 ELBW infants had a mean birth weight of (892±83) g and a mean gestational age of (28.2±2.3) weeks. There was no significant difference between the two groups in the incidence rates of hemodynamically significant patent ductus arteriosus, intraventricular hemorrhage, neonatal necrotizing enterocolitis, retinopathy of prematurity, bronchopulmonary dysplasia (BPD), grade Ⅲ BPD, sepsis, and pneumonia (P > 0.05). There was also no significant difference in the duration of parenteral nutrition, the age of total enteral nutrition, and head circumference/body length/body weight at discharge between the two groups (P > 0.05). Of all the infants, 22 (45%) had parenteral nutrition-associated cholestasis (PNAC), with 13 (50%) in the SMOF group and 9 (39%) in the MCT/LCT group but there was no significant difference in the incidence of PNAC between the two groups (P > 0.05); however, the infants with PNAC in the SMOF group had significantly lower peak values of direct bilirubin and alanine aminotransferase than those in the MCT/LCT group (P < 0.05). Conclusions The application of multi-oil fat emulsion in ELBW infants does not reduce the incidence rate of complications, but compared with MCT/LCT emulsion, SMOF can reduce the severity of PNAC in ELBW infants.