影响早产儿发生胃肠外营养相关性胆汁淤积的多因素分析

Multivariate analysis of risk factors of parenteral nutrition associated cholestasis in preterm infants

目的探讨早产儿发生胃肠外营养相关性胆汁淤积(PNAC)的危险因素。方法以2010年1月—2012年12月在郑州市妇幼保健院新生儿科接受肠外营养(PN)支持的240例新生儿为研究对象。根据是否发生胆汁淤积症,将其分为胆汁淤积症组和未发生胆汁淤积症组。对两组的临床资料进行单因素分析,根据单因素分析结果,再利用Logistic回归分析进行早产儿PNAC多因素分析。结果 240例早产儿中共发生PNAC 35例,占14.58%。单因素分析结果提示两组胎龄、出生体重、感染、喂养不耐受、PN持续时间、达到全胃肠内营养时间、氨基酸累积用量比较均有统计学意义。利用Logistic回归分析对上述指标进行多因素分析,结果提示胎龄、出生体重、PN持续时间、感染与PNAC发生有关,其中PN持续时间是PNAC发生的独立高危因素。结论胎龄越小,出生体重越轻,PN持续时间越长,发生PNAC的危险性越大,因此做好围生期的监测和保健,降低早产儿的出生率,尽早肠内喂养,缩短PN时间,是降低早产儿PNAC的重要措施。

Objective To detect the risk factors of parenteral nutrition -associated cholestasis （PNAC）in preterm infants. Methods A total of 240 preterm infants who had accepted parenteral nutrition from Zhengzhou Maternity and Child Health Care Hospital in Jan 2010 - Feb,2012 were included in this study. The patients were assigned into the PNAC group and the control group. The clinical datas in two groups by univariate analysis, and according to the results of univariate analysis,multi- variate analysis of PNAC in preterm infants by Logistic regression analysis. Results The incidence of PNAC in preterm in- fants was 14. 58%. Univariate analysis results suggest that gestational age,birth weight,infections,feeding intolerance,PN du- ration,the time to achieve total parenteral nutrition,amino acids cumulative dosage were statistically significant in two groups. logistic regression analysis suggest that Gestational age,birth weight,persistence time in PN and infection were all closely cor- related with PNAC. The pesistance time in PN was an independent risk factor of PNAC. Conclusion The smaller the gesta- tional age,the lighter birth weight,the longer the PN duration are the greater the risk of the occurrence of PNAC. The monito- ring and care in the perinatal period ,should strenght and reduce the birth rate of premature children ,and early enteral feeding and shortening the time of PN is the important measures to lower the incidence of PNCA.