目的探讨极低出生体质量儿(VLBWI)早期应用不同剂量氨基酸营养策略的有效性和安全性。方法 VLBWI 30例随机分为3组,每组各10例。高剂量氨基酸组:出生24 h内予2.0 g.kg-1.d-1氨基酸静脉输入,后增加1.0 g.kg-1.d-1,目标剂量为氨基酸3.5 g.kg-1.d-1。低剂量氨基酸组:出生24 h内予1.0 g.kg-1.d-1氨基酸,后增加1.0 g.kg-1.d-1,目标剂量为氨基酸3.5 g.kg-1.d-1。对照组:出生24 h不予氨基酸,出生第2天予1.0 g.kg-1.d-1氨基酸,后增加1.0 g.kg-1.d-1,目标剂量为氨基酸3.5 g.kg-1.d-1。比较3组VLBWI氮平衡、能量摄入、血氨基酸、血胆红素、尿素氮、肌酐、血糖等生化指标。结果高剂量组VLBWI体质量下降百分比、体质量回升天数均低于对照组(Pa<0.05),低剂量组体质量下降百分比、体质量回升天数与对照组比较差异均无统计学意义(Pa>0.05)。3组VLBWI第1、7天血糖、血清尿素氮、肌酐、总胆红素、结合胆红素、AST、ALT比较差异均无统计学意义(Pa>0.05),高剂量组和低剂量组患儿第1、7天氮平衡均高于对照组(Pa<0.05)。3组VLBWI第1天血17种氨基酸比较差异均无统计学意义(Pa>0.05),高剂量组患儿第7天血天冬氨酸、亮氨酸、异亮氨酸、缬氨酸均高于对照组(Pa<0.05),其余氨基酸比较差异均无统计学意义(Pa>0.05)。3组患儿病死率比较差异无统计学意义。结论 VLBWI出生24 h内即开始静脉输注2.0 g.kg-1.d-1氨基酸可避免负氮平衡,减少体质量下降百分比,缩短体质量回升天数,无明显不良反应。 Objective To investigate the efficacy and safety of early dosage of different doses of amino acid nutrition for very low birth weight children (VLBWI). Methods Thirty patients with VLBWI were randomly divided into 3 groups with 10 cases in each group. High-dose amino acid group: intravenous infusion of 2.0 g.kg-1.d-1 amino acids within 24 hours of birth, then increase 1.0 g.kg-1.d-1, the target dose of amino acids 3.5 g.kg-1.d- 1. In the low-dose amino acid group, 1.0 g.kg-1.d-1 amino acid was added within 24 hours of birth, then 1.0 g.kg-1.d-1 was added, and the target dose was 3.5 g.kg-1.d-1. In the control group, no amino acids were found at 24 h after birth, 1.0 g.kg-1.d-1 amino acids were added on the second day of life, 1.0 g.kg-1.d-1 was added afterwards, and the target dose was 3.5 g.kg-1 .d-1. The biochemical indexes such as nitrogen balance, energy intake, serum amino acids, serum bilirubin, urea nitrogen, creatinine and blood glucose in VLBWI were compared among the three groups. Results Compared with the control group, the VLBWI body weight loss percentage and body weight recovery days in the high-dose group were significantly lower than those in the control group (Pa <0.05). The body weight loss percentage and body weight recovery days in the low-dose group were not significantly different from those in the control group (Pa> 0.05). Blood glucose, serum urea nitrogen, creatinine, total bilirubin, conjugated bilirubin, AST and ALT were not significantly different in the three groups at the first day (P> 0.05). The high dose group and the low dose group Nitrogen balance at day 1,7 was higher than that in control group (Pa <0.05). There was no significant difference in the 17 amino acids in the first day of VLBWI among the three groups (Pa> 0.05). The levels of aspartate, leucine, isoleucine and valine Higher than the control group (Pa <0.05), the other amino acids showed no significant difference (Pa> 0.05). There was no significant difference in mortality among the three groups. Conclusion Intravenous infusion of 2.0 g.kg-1.d-1 amino acids within 24 hours after birth of VLBWI can avoid negative nitrogen balance, reduce the percentage of body weight loss, shorten the days of body weight recovery, and have no obvious adverse reactions.