早产儿肝胆并发症高危因素及早期干预的临床研究

Clinical study of the risk factors and early intervention of the preterm infants' hepatobiliary complications

目的分析早产儿胃肠道外营养(PN)相关肝胆并发症的发病率、高危因素及早期干预。方法对30例PN早产儿的肠外营养开始日龄、持续时间及葡萄糖、氨基酸和脂肪乳应用情况,PN热卡摄入量,达到全肠道营养时间,有无出现胃肠道外营养相关胆汁淤积(PNAC)并发症进行观察及记录,并进行谷丙转氨酶、总胆红素、结合胆红素、碱性磷酸酶生化指标检测。结果 5例PN早产儿出现PNAC,占16.7%;PNAC患儿与无PNAC患儿在脂肪乳、氨基酸、葡萄糖累积用量及PN开始日龄、PN时间、PN热卡摄入量、达到全肠道营养时间方面比较,差异有统计学意义(P<0.05);PN后2周谷丙转氨酶、总胆红素、结合胆红素、碱性磷酸酶,PNAC组明显高于无PNAC组,差异有统计学意义(P<0.05)。结论 PN持续时间过长可大大增加胆汁淤积损伤肝脏的几率,尽早地开始肠内营养,是避免出现与PN相关肝胆并发症的有效措施,密切监测患儿的肝肾功能、胆红素指标,可帮助减少早产儿肝胆并发症的发生。

Objective To analyze the incidence of the disease,the risk factors and early intervention of relavent hepatobiliary complications from the parenteral nutrition（PN） children.Methods The beginning day of the parenteral nutrition,the resisting time,the uesage of glucose,amino acids and fat emulsion,the PN caloric intake,the time of enteral nutrition,with or without parenteral nutrition-associated cholestasis（PNAC） complications were observed and detected from 30 cases of PN preterm infants.Then biochemical markers of alanine aminotransferase,total bilirubin,direct bilirubin and alkaline phosphatase were detected.Results 5 cases of PN preterm infants had PNAC,was 16.7%;there was statistically significant（P0.05） in aspect of the cumulative dosage of the fat emulsion,amino acids and glucose,the PN beginning day,PN time, PN caloric intake,and the enteral nutrition time between PNAC children and non-PNAC children.After 2 weeks of PN, the alanine aminotransferase,total bilirubin,direct bilirubin,and alkaline phosphatase of the PNAC group were significantly higher than the non PNAC group,there were significant differences（P0.05）.Conclusion PN duration too long can greatly increase the probability of liver damage by cholestasis.So starting enteral nutrition as early as possible is effective to avoid the emergence of PN-related hepatobiliary complications.Closely monitoring the children＇s liver and kidney function and the bilirubin index can help reduce the incidence of hepatobiliary complications of premature children.