极低出生体重儿长期胃肠外营养相关性胆汁淤积的发生率及防治

Incidence and prevention of parenteral nutrition-associated cholestasis in infants with very low birth weight

目的研究极低出生体重儿长期胃肠外营养相关性胆汁淤积的发生率及防治措施。方法选择2006年1月至2010年6月在本院新生儿科住院并采用胃肠外静脉营养14d以上的极低出生体重儿共47例,分为发生新生儿肠外营养相关性胆汁淤积(PNAC)及未发生PNAC两组,进行单因素及多因素Logistic回归模型分析。结果 PNAC的发生率为17.02%。条件logistic回归分析显示达到全肠道营养时间、PN持续时间、开始胃肠喂养时间、葡萄糖积累用量、氨基酸积累用量、脂肪积累用量与PNAC密切相关,PN持续时间是独立高危因素(OR=3.812,95%CI:0.039～4.027,P=0.012)。结论 PN持续时间越长、PN氨基酸的累积用量越大、PN脂肪乳累积用量越大、达到全肠道营养的时间越长,则发生PNAC的几率越大。尽早开始肠内营养,避免静脉摄入高热卡,为降低PNAC的重要措施。

Objective To study the incidence and prevention of parenteral nutrition-associated cholestasis （PNAC） in infants with very low birth weight （VLBW）. Methods From Jan. 2006 to Jun. 2010, 47 infants with VLBW were given parenteral nutyition （PN） for more than 14 days in the Department of Pediatrics in our hospital. They were divided into two groups： with PNAC or without PNAC. Logistic regression analysis were performed. Re sults The incidence of PNAC was 17.02 %. Logistic regression analysis showed that time to establish enteral nutrition, PN duration, initial time of enteral feeding, glucose accumulation dosage, amino acids accumulate dosage, fat milk accumulate amount are closely related to PNAC. PN duration was the independent high risk factors （OR =3.812, 95% CI 0.039～4.027,P =0.012）. Conclusion The incidence of PNAC increased as the increase of the cumulative amount of PN amino acid, the cumulative amount PN fat emulsion, the time of attaining full intestinal nutrients, thelonger the greater chance of PNAC occurred and the time to establish enteral nutrition. Two important measures to reduce the incidence of PNAC are to start enteral nutrition early and to avoid venous intake for high calorie.