早产儿生后早期对脂肪乳的耐受性研究
发布时间：2018-12-10 17:00
【摘要】：1.研究背景及目的1.1研究背景无论是发展中国家还是发达国家,早产儿的营养和生长管理仍然是新生儿重症监护室(neonatal intensive care unit,NICU)的一个巨大挑战。脂肪乳提供了全静脉营养(total parentral nutrition,TPN)早产儿25-40%的非蛋白热卡。对于早产儿来说,常规监测其血清甘油三酯及胆固醇浓度波动情况发现,持续静脉输入每天3g/kg的脂肪乳是可以耐受的。但从代谢组学的角度,却鲜有针对当前脂肪乳剂量的耐受性研究报告。有文献表明,早产儿早期应用脂肪乳是安全的,并且能预防其必需脂肪酸的缺乏。尽管各营养指南推荐脂肪乳的起始剂量为每天1g/kg,增加速度为每天0.5-1.Og/kg,直到每天3.Og/kg,但其推荐证据强度仍待进一步提高。目前仍需进一步研究使用哪种类型的脂肪乳(大豆油、橄榄油等)较好,以及最佳脂肪乳的剂量是多少。另外,目前对不同胎龄段早产儿的起始推荐剂量、增加速度均一概而论,没有细化,但实际上,早产儿的基础代谢能力及肝肾功能的成熟度与出生胎龄密切相关,因此其对脂肪乳的代谢能力也可能有所区别。1.2研究目的探讨生后早期不同剂量脂肪乳策略对早产儿的影响,以及通过对比不同胎龄段早产儿(超早产儿、早期早产儿与中晚期早产儿)生后早期体内短、中、长链酰基肉碱浓度的差异及相同胎龄段早产儿对不同剂量脂肪乳的代谢状态,来分析早产儿生后早期对脂肪乳的代谢特点,为临床工作者在早产儿生后早期更好地应用脂肪乳提供实验依据。2.研究方法选取我院新生儿重症监护室2014年5-10月住院的98名早产儿,根据脂肪乳剂量的高低,分为低脂肪乳组与高脂肪乳组两个大组。再根据出生胎龄(GA)分为超早产儿组(GA28周)、早期早产儿组(28周≤GA32周)和中晚期早产儿组(32周≤GA37周),每组内再分为低脂肪乳组与高脂肪乳组两个亚组。留取脐血及出生后前三天血干滤纸片及尿标本,用串联质谱法检测血标本短中长链酰基肉碱含量,用气相色谱-质谱联用检测尿标本的有机酸含量,先对高低剂量脂肪乳两组早产儿的酰基肉碱及有机酸含量进行比较分析,再对三个胎龄段的早产儿及其亚组的酰基肉碱含量进行比较分析。3.研究结果3.1对高低剂量脂肪乳两组早产儿的酰基肉碱及有机酸含量比较分析结果:①两组的血短中长链酰基肉碱中,出生时,只有中链的辛酰肉碱有统计学差异(p0.05);生后第一天及第二天,部分长链酰基肉碱有统计学差异(p0.05);生后第三天,部分中长链酰基肉碱有统计学差异(p0.05)。②两组的尿有机酸含量中,生后前三天均没有统计学差异。③两组的生后第一次血清甘油三酯没有统计学差异。④两组住院期间主要并发症发生情况没有统计学差异。3.2对三个胎龄段的早产儿及其亚组的酰基肉碱含量比较分析结果:各胎龄段早产儿的脐血及前三天短中链酰基肉碱浓度无统计学差异,但超早产儿组与早期早产儿组的生后前三天长链酰基肉碱浓度均低于中晚期早产儿组(p0.05),且长链酰基肉碱浓度改变与胎龄成正相关。超早产儿组中,低脂肪乳组的第二天短中长链酰基肉碱浓度均高于高脂肪乳组(p0.05)。早期早产儿组与中晚期早产儿组中,亚组的前三天短中长链酰基肉碱浓度均没有统计学差异。4.研究主要结论从代谢组学的角度发现,高剂量脂肪乳可能会导致部分中长链酰基肉碱在早产儿的体内堆积。超早产儿和早期早产儿生后前三天对长链脂肪酸的代谢能力均低于中晚期早产儿;早期早产儿与中晚期早产儿生后早期可以耐受本研究中的高剂量脂肪乳,但超早产儿生后早期对本研究中的高剂量脂肪乳代谢能力可能不足。
[Abstract]:1. The background and purpose of the study are as follows: the nutritional and growth management of premature infants is still a great challenge for the neonatal intensive care unit (NICU), both in developing and developed countries. Fat emulsion provides 25-40% non-protein thermal card of total parenteral nutrition (TPN) prematurity. For premature infants, routine monitoring of the fluctuation of serum triglyceride and cholesterol concentrations found that a continuous intravenous injection of 3 g/ kg of fat emulsion per day was tolerable. However, there are few studies on the tolerability of the current fat emulsion dose from the point of view of the metabolic group. The literature has shown that early use of fat milk in premature infants is safe and can prevent the lack of essential fatty acids. Although the starting dose of the fat emulsion recommended for each nutrition guide is 1 g/ kg per day, the increase rate is from 0.5 to 1. Og/ kg per day, up to 3. Og/ kg per day, but the recommended evidence strength remains to be further improved. It is still necessary to further study which type of fat emulsion (soybean oil, olive oil, etc.) is used, as well as the amount of the optimal fat emulsion. In addition, at present, the initial recommended dose and the increasing rate of the premature infants of different gestational age are not refined, but in practice, the basal metabolic capacity of the premature infant and the maturity of the liver and kidney function are closely related to the age of the birth, Therefore, it is also possible to distinguish the metabolic ability of fat milk. The difference of the concentration of the L-carnitine in the long chain and the metabolic status of the premature infants with the same gestational age on the fat milk of different doses were analyzed, and the metabolic characteristics of the fat milk in the early stage of the premature infants were analyzed, and the experimental basis for the early and better application of the fat emulsion was provided for the clinical workers. Methods 98 premature infants hospitalized in the neonatal intensive care unit in our hospital from May to October, 2014 were selected and divided into two large groups of low fat emulsion and high fat emulsion according to the fat milk dosage. According to the age of birth (GA), it was divided into the prematurity group (GA28), the early prematurity group (28 weeks, the GGA32 week) and the middle and late-term premature infants (32 weeks, the GGA37 week), and the group was divided into the lower fat emulsion group and the high fat emulsion group. the method comprises the following steps of: taking the umbilical blood and the blood-dried filter paper sheet and the urine sample for three days after birth, detecting the content of the long-chain and long-chain-base carnitine in the blood sample by using the tandem mass spectrometry, and detecting the organic acid content of the urine sample by using the gas chromatography-mass spectrometry; The content of L-carnitine and organic acid in the two groups of premature infants with high and low-dose fat emulsion were compared and analyzed. The results of the study on the results of the comparative analysis of the content of L-carnitine and organic acid in the two groups of low-and-high-dose fat-milk in the two groups were compared and the results showed that in the two groups, the two groups of the two groups had a statistically significant difference in the L-carnitine in the medium chain (p0.05), and the first and the second day after the birth. There was a significant difference in the content of L-carnitine in some long chain (p0.05); in the third day of the second day, there was a statistical difference in the L-carnitine in the long-chain group (p0.05). There was no statistical difference in the urine organic acid content of the two groups in the first three days. There was no statistical difference in the first serum triglycerides in the first two groups. There was no statistical difference in the incidence of major complications in the two groups. However, the concentration of L-carnitine in the prematurity group and the early prematurity group was lower than that of the middle and late-term premature infants (p0.05), and the change of the concentration of the long-chain L-carnitine was positively related to the gestational age. In the prematurity group, the concentration of L-carnitine in the short of the second day of the low fat emulsion group was higher than that of the high fat emulsion group (p0.05). There was no statistical difference in the concentration of L-carnitine in the early and middle-term prematurity group and in the middle and late-term prematurity group. The main conclusions of the study are that the high-dose fat emulsion may lead to the accumulation of long-chain-carnitine in the body of the premature infant from the point of view of the metabolic group. the metabolic capacity of the long-chain fatty acid is lower than that of the middle and late-term premature infants in the first three days after the prematurity of the premature infants and the early-term infants, and the high-dose fat emulsion in the study can be tolerated in the early-stage premature infants and the early-stage premature infants, However, the high-dose fat milk metabolism in this study may be insufficient in the early stage of prematurity.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R722.6
[Abstract]:1. The background and purpose of the study are as follows: the nutritional and growth management of premature infants is still a great challenge for the neonatal intensive care unit (NICU), both in developing and developed countries. Fat emulsion provides 25-40% non-protein thermal card of total parenteral nutrition (TPN) prematurity. For premature infants, routine monitoring of the fluctuation of serum triglyceride and cholesterol concentrations found that a continuous intravenous injection of 3 g/ kg of fat emulsion per day was tolerable. However, there are few studies on the tolerability of the current fat emulsion dose from the point of view of the metabolic group. The literature has shown that early use of fat milk in premature infants is safe and can prevent the lack of essential fatty acids. Although the starting dose of the fat emulsion recommended for each nutrition guide is 1 g/ kg per day, the increase rate is from 0.5 to 1. Og/ kg per day, up to 3. Og/ kg per day, but the recommended evidence strength remains to be further improved. It is still necessary to further study which type of fat emulsion (soybean oil, olive oil, etc.) is used, as well as the amount of the optimal fat emulsion. In addition, at present, the initial recommended dose and the increasing rate of the premature infants of different gestational age are not refined, but in practice, the basal metabolic capacity of the premature infant and the maturity of the liver and kidney function are closely related to the age of the birth, Therefore, it is also possible to distinguish the metabolic ability of fat milk. The difference of the concentration of the L-carnitine in the long chain and the metabolic status of the premature infants with the same gestational age on the fat milk of different doses were analyzed, and the metabolic characteristics of the fat milk in the early stage of the premature infants were analyzed, and the experimental basis for the early and better application of the fat emulsion was provided for the clinical workers. Methods 98 premature infants hospitalized in the neonatal intensive care unit in our hospital from May to October, 2014 were selected and divided into two large groups of low fat emulsion and high fat emulsion according to the fat milk dosage. According to the age of birth (GA), it was divided into the prematurity group (GA28), the early prematurity group (28 weeks, the GGA32 week) and the middle and late-term premature infants (32 weeks, the GGA37 week), and the group was divided into the lower fat emulsion group and the high fat emulsion group. the method comprises the following steps of: taking the umbilical blood and the blood-dried filter paper sheet and the urine sample for three days after birth, detecting the content of the long-chain and long-chain-base carnitine in the blood sample by using the tandem mass spectrometry, and detecting the organic acid content of the urine sample by using the gas chromatography-mass spectrometry; The content of L-carnitine and organic acid in the two groups of premature infants with high and low-dose fat emulsion were compared and analyzed. The results of the study on the results of the comparative analysis of the content of L-carnitine and organic acid in the two groups of low-and-high-dose fat-milk in the two groups were compared and the results showed that in the two groups, the two groups of the two groups had a statistically significant difference in the L-carnitine in the medium chain (p0.05), and the first and the second day after the birth. There was a significant difference in the content of L-carnitine in some long chain (p0.05); in the third day of the second day, there was a statistical difference in the L-carnitine in the long-chain group (p0.05). There was no statistical difference in the urine organic acid content of the two groups in the first three days. There was no statistical difference in the first serum triglycerides in the first two groups. There was no statistical difference in the incidence of major complications in the two groups. However, the concentration of L-carnitine in the prematurity group and the early prematurity group was lower than that of the middle and late-term premature infants (p0.05), and the change of the concentration of the long-chain L-carnitine was positively related to the gestational age. In the prematurity group, the concentration of L-carnitine in the short of the second day of the low fat emulsion group was higher than that of the high fat emulsion group (p0.05). There was no statistical difference in the concentration of L-carnitine in the early and middle-term prematurity group and in the middle and late-term prematurity group. The main conclusions of the study are that the high-dose fat emulsion may lead to the accumulation of long-chain-carnitine in the body of the premature infant from the point of view of the metabolic group. the metabolic capacity of the long-chain fatty acid is lower than that of the middle and late-term premature infants in the first three days after the prematurity of the premature infants and the early-term infants, and the high-dose fat emulsion in the study can be tolerated in the early-stage premature infants and the early-stage premature infants, However, the high-dose fat milk metabolism in this study may be insufficient in the early stage of prematurity.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R722.6
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