不同胎龄早产儿生后早期对脂肪乳的耐受性研究

Fat emulsion tolerance in preterm infants of different gestational ages in the early stage after birth

摘要:

目的 分析不同出生胎龄早产儿生后早期对脂肪乳的耐受性。方法 98例早产儿分为超早产儿组（n=17）、早期早产儿组（n=48）和中晚期早产儿组（n=33），再根据脂肪乳剂量分为低剂量脂肪乳与高剂量两个亚组，留取脐血及生后前3 d的血干滤纸片，用串联质谱法检测短、中、长链酰基肉碱含量。结果 超早产儿组与早期早产儿组脐血及生后前3 d长链酰基肉碱浓度均低于中晚期早产儿组（P < 0.05），且长链酰基肉碱浓度与胎龄呈正相关（P < 0.01）。超早产儿低剂量脂肪乳组生后第2天的短、中、长链酰基肉碱浓度均高于高剂量组（P < 0.05），而早期早产儿与中晚期早产儿不同剂量脂肪乳亚组的生后3 d短、中、长链酰基肉碱浓度差异均无统计学意义。结论 超早产儿和早期早产儿生后前3 d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高剂量脂肪乳，但超早产儿生后早期对高剂量脂肪乳代谢能力可能不足。

Abstract:

Objective To investigate the fat emulsion tolerance in preterm infants of different gestational ages in the early stage after birth. Methods A total of 98 preterm infants were enrolled and divided into extremely preterm infant group (n=17), early preterm infant group (n=48), and moderate-to-late preterm infant group (n=33). According to the dose of fat emulsion, they were further divided into low-and high-dose subgroups. The umbilical cord blood and dried blood filter papers within 3 days after birth were collected. Tandem mass spectrometry was used to measure the content of short-, medium-, and long-chain acylcarnitines. Results The extremely preterm infant and early preterm infant groups had a significantly lower content of long-chain acylcarnitines in the umbilical cord blood and dried blood filter papers within 3 days after birth than the moderate-to-late preterm infant group (P < 0.05), and the content was positively correlated with gestational age (P < 0.01). On the second day after birth, the low-dose fat emulsion subgroup had a significantly higher content of short-, medium-, and long-chain acylcarnitines than the high-dose fat emulsion subgroup among the extremely preterm infants (P < 0.05). In the early preterm infant and moderate-to-late preterm infant groups, there were no significant differences in the content of short-, medium-, and long-chain acylcarnitines between the low-and high-dose fat emulsion subgroups within 3 days after birth. Conclusions Compared with moderate-to-late preterm infants, extremely preterm infants and early preterm infants have a lower capacity to metabolize long-chain fatty acids within 3 days after birth. Early preterm infants and moderate-to-late preterm infants may tolerate high-dose fat emulsion in the early stage after birth, but extremely preterm infants may have an insufficient capacity to metabolize high-dose fat emulsion.