早产儿胃肠外营养相关性胆汁淤积的临床研究

Clinical research of parenteral nutrition-associated cholestasis in preterm children

目的探讨早产儿胃肠外营养相关性胆汁淤积(PNAC)的相关因素及防治措施。方法对100例进行静脉营养支持≥14d的早产儿临床资料进行分析,按是否发生PNAC分成PNAC组及非PNAC组。结果早产儿PNAC发生率为26%,PNAC组的胎龄、出生体重分别为(30.88±2.01)d和(1235.38±221.53)g,小于非PNAC组的(31.94±1.66)d和(1499.86±281.38)g,P均<0.05;PNAC组出生体重恢复时间长于非PNAC组,但P>0.05;而PNAC组胃肠外营养持续时间、脂肪乳最大剂量、氨基酸最大剂量分别为(31.81±15.13)d,(2.77±0.32)g·kg-1·d-1,(2.63±0.36)g·kg-1·d-1,均大于非PNAC组的(21.00±6.35)d,(2.05±0.40)g·kg-1·d-1,(2.14±0.30)g·kg-1·d-1,P<0.05。结论 PNAC发生与胎龄小、出生体重低、胃肠外营养持续时间长以及大剂量脂肪乳、氨基酸的应用有关。防治PNAC的措施包括尽早开始经口喂养,尽早过渡为全胃肠营养,静脉营养配比适宜,及时应用调节肠道菌群及利胆降酶药物。

Objective To discuss the relevant factors and preventive measures of parenteral nutrition-associated cholestasis(PNAC) in preterm children.Methods 100 cases of preterm children who had received intravenous nutrition for more than 14-day were analyzed,and were divided into PNAC group and non-PNAC group according to whether there was PNAC.Results Incidence of PNAC in preterm children was 26%.The gestational age and birth weight of PNAC group were(30.88±2.01)d and(1235.38±221.53)g,respectively,which were less than non-PNAC group[(31.94±1.66)d and(1499.86±281.38)g,respectively,P<0.05].The recovery time of birth weight of PNAC group was longer than the non-PNAC group(P>0.05).The duration of parenteral nutrition,maximum dose of intralipid and amino acids of PNAC group were(31.81±15.13) d,(2.77±0.32)g·kg-1·d-1,(2.63±0.36)g·kg-1·d-1,respectively,which were higher than non-PNAC group[(21.00±6.35) d,(2.05±0.40)g·kg-1·d-1,(2.14±0.30)g·kg-1·d-1,respectively,P<0.05].Conclusions The occurrence of PNAC was associated with small gestational age,low birth weight,long duration of parenteral nutrition and large doses of intralipid and amino acids.Prevention measures of PNAC included starting oral feeding and transition to total enteral nutrition as soon as possible,suitable parenteral nutrition ratio,timely application of regulation of intestinal flora and drugs to promote bile discharge and decrease the transaminase.