Reynolds Regina M, Bass Kathryn D, Thureen Patti J
Section of Neonatology, Department of Pediatrics, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA.
J Pediatr. 2008 Jan;152(1):63-7. doi: 10.1016/j.jpeds.2007.05.042. Epub 2007 Sep 17.
To determine whether neonates undergoing major abdominal surgical procedures in the first day of life could achieve a positive protein balance without protein toxicity in the immediate perioperative period by using parenteral amino acids and fentanyl analgesia.
Newborns undergoing major surgery for gastroschisis in the first 24 hours of life (n = 13) were alternately allocated to immediate postoperative parenteral administration of 1.5 g/kg(-1)/day(-1) versus 2.5 g/kg(-1)/day(-1) amino acids. Protein balance was determined at 1.6 to 2.6 days postoperatively with both nitrogen balance and leucine stable isotope methodology. Statistical analyses were conducted with the unpaired t test and linear regression.
Protein balance was significantly different in the 2 groups with both nitrogen balance and leucine stable isotope methodology. There was no evidence of protein toxicity as determined with blood urea nitrogen, creatinine, and ammonia concentrations.
Neonates undergoing the metabolic stress of abdominal surgery shortly after birth are able to achieve a net positive protein balance with parenteral amino acid administration without evidence of protein intolerance.
确定出生首日接受大型腹部外科手术的新生儿在围手术期即刻通过肠外氨基酸和芬太尼镇痛是否能实现正性蛋白质平衡且无蛋白质毒性。
出生后24小时内接受腹裂大型手术的新生儿（n = 13）被交替分配至术后即刻肠外给予1.5 g/kg⁻¹/天⁻¹与2.5 g/kg⁻¹/天⁻¹氨基酸。术后1.6至2.6天采用氮平衡和亮氨酸稳定同位素方法测定蛋白质平衡。采用不成对t检验和线性回归进行统计分析。
两组采用氮平衡和亮氨酸稳定同位素方法时蛋白质平衡存在显著差异。根据血尿素氮、肌酐和氨浓度测定，无蛋白质毒性证据。
出生后不久经历腹部手术代谢应激的新生儿通过肠外给予氨基酸能够实现净正性蛋白质平衡，且无蛋白质不耐受证据。
