Chessex P, Bélanger S, Piedboeuf B, Pineault M
Perinatal Service, Pharmacy and Research Center, Hôpital Sainte Justine, Montreal, Quebec, Canada.
J Pediatr. 1995 Apr;126(4):619-24. doi: 10.1016/s0022-3476(95)70364-0.
The purpose of this study was to determine the optimal parenteral feeding regimen for infants with compromised respiratory function.
We studied the influence of varying the source of energy on respiratory gas exchange in 10 infants who were supported by mechanical ventilation and who received intravenous feedings. Two isoenergetic parenteral regimens were infused consecutively; the level of fat intake was varied inversely with that of glucose. Under similar ventilator settings, transcutaneous partial pressures of oxygen and carbon dioxide, as well as indirect calorimetry were measured during each regimen.
Despite the higher carbon dioxide production during the glucose-rich regimen (8.9 +/- 0.7 vs 7.9 +/- 0.4 ml/kg per minute, p < 0.05 by analysis of variance), transcutaneous partial pressure of carbon dioxide remained unaffected, suggesting ventilatory compensation as documented by the increased (p < 0.002) alveolar ventilation. This was not associated with a detectable rise in oxygen consumption, but with a significant change in partial pressure of oxygen (77 +/- 5 vs 66 +/- 3 mm Hg, p < 0.05).
Ventilator-dependent infants with early and mild bronchopulmonary dysplasia, who receive intravenous feedings of a moderate load of glucose-based energy, can compensate for enhanced carbon dioxide production by increasing their respiratory drive, with a beneficial effect on oxygenation compared with that observed when energy is derived from lipid-based solutions.
本研究旨在确定呼吸功能受损婴儿的最佳肠外营养方案。
我们研究了能量来源变化对10例接受机械通气和静脉喂养的婴儿呼吸气体交换的影响。连续输注两种等能量的肠外营养方案；脂肪摄入量与葡萄糖摄入量呈反比变化。在相似的呼吸机设置下，在每种方案期间测量经皮氧分压和二氧化碳分压以及间接测热法。
尽管在富含葡萄糖的方案期间二氧化碳产生量较高（8.9±0.7 vs 7.9±0.4 ml/kg每分钟，方差分析p<0.05），但经皮二氧化碳分压未受影响，提示通过增加（p<0.002）肺泡通气记录的通气代偿。这与可检测到的氧耗增加无关，但与氧分压的显著变化有关（77±5 vs 66±3 mmHg，p<0.05）。
依赖呼吸机的早期轻度支气管肺发育不良婴儿，接受中等负荷基于葡萄糖能量的静脉喂养时，可通过增加呼吸驱动来代偿增强的二氧化碳产生，与能量来源于基于脂质的溶液时相比，对氧合有有益影响。
