早產(chǎn)兒生后早期對(duì)脂肪乳的耐受性研究
發(fā)布時(shí)間：2018-12-10 17:00
【摘要】：1.研究背景及目的1.1研究背景無(wú)論是發(fā)展中國(guó)家還是發(fā)達(dá)國(guó)家,早產(chǎn)兒的營(yíng)養(yǎng)和生長(zhǎng)管理仍然是新生兒重癥監(jiān)護(hù)室(neonatal intensive care unit,NICU)的一個(gè)巨大挑戰(zhàn)。脂肪乳提供了全靜脈營(yíng)養(yǎng)(total parentral nutrition,TPN)早產(chǎn)兒25-40%的非蛋白熱卡。對(duì)于早產(chǎn)兒來(lái)說(shuō),常規(guī)監(jiān)測(cè)其血清甘油三酯及膽固醇濃度波動(dòng)情況發(fā)現(xiàn),持續(xù)靜脈輸入每天3g/kg的脂肪乳是可以耐受的。但從代謝組學(xué)的角度,卻鮮有針對(duì)當(dāng)前脂肪乳劑量的耐受性研究報(bào)告。有文獻(xiàn)表明,早產(chǎn)兒早期應(yīng)用脂肪乳是安全的,并且能預(yù)防其必需脂肪酸的缺乏。盡管各營(yíng)養(yǎng)指南推薦脂肪乳的起始劑量為每天1g/kg,增加速度為每天0.5-1.Og/kg,直到每天3.Og/kg,但其推薦證據(jù)強(qiáng)度仍待進(jìn)一步提高。目前仍需進(jìn)一步研究使用哪種類型的脂肪乳(大豆油、橄欖油等)較好,以及最佳脂肪乳的劑量是多少。另外,目前對(duì)不同胎齡段早產(chǎn)兒的起始推薦劑量、增加速度均一概而論,沒(méi)有細(xì)化,但實(shí)際上,早產(chǎn)兒的基礎(chǔ)代謝能力及肝腎功能的成熟度與出生胎齡密切相關(guān),因此其對(duì)脂肪乳的代謝能力也可能有所區(qū)別。1.2研究目的探討生后早期不同劑量脂肪乳策略對(duì)早產(chǎn)兒的影響,以及通過(guò)對(duì)比不同胎齡段早產(chǎn)兒(超早產(chǎn)兒、早期早產(chǎn)兒與中晚期早產(chǎn)兒)生后早期體內(nèi)短、中、長(zhǎng)鏈�；鈮A濃度的差異及相同胎齡段早產(chǎn)兒對(duì)不同劑量脂肪乳的代謝狀態(tài),來(lái)分析早產(chǎn)兒生后早期對(duì)脂肪乳的代謝特點(diǎn),為臨床工作者在早產(chǎn)兒生后早期更好地應(yīng)用脂肪乳提供實(shí)驗(yàn)依據(jù)。2.研究方法選取我院新生兒重癥監(jiān)護(hù)室2014年5-10月住院的98名早產(chǎn)兒,根據(jù)脂肪乳劑量的高低,分為低脂肪乳組與高脂肪乳組兩個(gè)大組。再根據(jù)出生胎齡(GA)分為超早產(chǎn)兒組(GA28周)、早期早產(chǎn)兒組(28周≤GA32周)和中晚期早產(chǎn)兒組(32周≤GA37周),每組內(nèi)再分為低脂肪乳組與高脂肪乳組兩個(gè)亞組。留取臍血及出生后前三天血干濾紙片及尿標(biāo)本,用串聯(lián)質(zhì)譜法檢測(cè)血標(biāo)本短中長(zhǎng)鏈�；鈮A含量,用氣相色譜-質(zhì)譜聯(lián)用檢測(cè)尿標(biāo)本的有機(jī)酸含量,先對(duì)高低劑量脂肪乳兩組早產(chǎn)兒的�；鈮A及有機(jī)酸含量進(jìn)行比較分析,再對(duì)三個(gè)胎齡段的早產(chǎn)兒及其亞組的�；鈮A含量進(jìn)行比較分析。3.研究結(jié)果3.1對(duì)高低劑量脂肪乳兩組早產(chǎn)兒的�；鈮A及有機(jī)酸含量比較分析結(jié)果:①兩組的血短中長(zhǎng)鏈�；鈮A中,出生時(shí),只有中鏈的辛酰肉堿有統(tǒng)計(jì)學(xué)差異(p0.05);生后第一天及第二天,部分長(zhǎng)鏈�；鈮A有統(tǒng)計(jì)學(xué)差異(p0.05);生后第三天,部分中長(zhǎng)鏈�；鈮A有統(tǒng)計(jì)學(xué)差異(p0.05)。②兩組的尿有機(jī)酸含量中,生后前三天均沒(méi)有統(tǒng)計(jì)學(xué)差異。③兩組的生后第一次血清甘油三酯沒(méi)有統(tǒng)計(jì)學(xué)差異。④兩組住院期間主要并發(fā)癥發(fā)生情況沒(méi)有統(tǒng)計(jì)學(xué)差異。3.2對(duì)三個(gè)胎齡段的早產(chǎn)兒及其亞組的酰基肉堿含量比較分析結(jié)果:各胎齡段早產(chǎn)兒的臍血及前三天短中鏈�；鈮A濃度無(wú)統(tǒng)計(jì)學(xué)差異,但超早產(chǎn)兒組與早期早產(chǎn)兒組的生后前三天長(zhǎng)鏈�；鈮A濃度均低于中晚期早產(chǎn)兒組(p0.05),且長(zhǎng)鏈�；鈮A濃度改變與胎齡成正相關(guān)。超早產(chǎn)兒組中,低脂肪乳組的第二天短中長(zhǎng)鏈�；鈮A濃度均高于高脂肪乳組(p0.05)。早期早產(chǎn)兒組與中晚期早產(chǎn)兒組中,亞組的前三天短中長(zhǎng)鏈�；鈮A濃度均沒(méi)有統(tǒng)計(jì)學(xué)差異。4.研究主要結(jié)論從代謝組學(xué)的角度發(fā)現(xiàn),高劑量脂肪乳可能會(huì)導(dǎo)致部分中長(zhǎng)鏈�；鈮A在早產(chǎn)兒的體內(nèi)堆積。超早產(chǎn)兒和早期早產(chǎn)兒生后前三天對(duì)長(zhǎng)鏈脂肪酸的代謝能力均低于中晚期早產(chǎn)兒;早期早產(chǎn)兒與中晚期早產(chǎn)兒生后早期可以耐受本研究中的高劑量脂肪乳,但超早產(chǎn)兒生后早期對(duì)本研究中的高劑量脂肪乳代謝能力可能不足。
[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.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：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.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R722.6
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