早产儿肠外营养相关性胆汁淤积的危险因素分析

Analysis of risk factors in parenteral nutrition associated cholestasis in preterm children

目的探讨早产儿肠外营养相关性胆汁淤积(PNAC)的危险因素。方法对新生儿重症监护病房进行肠外营养支持(>14天)治疗的91例早产儿资料进行回顾性分析,并根据患儿是否发生胆汁淤积分为PNAC组与非PNAC组。并比较两组患儿接受肠外营养支持治疗的时间、三大营养素提供热卡量、禁食时间及体重增长等情况。结果PNAC组与非PNAC组患儿在出生体重、开始喂养时间、肠外营养(PN)支持治疗持续时间、禁食时间、喂养不耐受、机械通气、胃肠道手术、败血症、NEC、窒息及SGA等方面差异均有统计学意义(P<0.05),而在肺炎发生、患儿出生胎龄、颅内出血及动脉导管开放等方面差异无统计学意义(P>0.05)。PNAC伴有肝损组患儿的胆汁淤积持续时间与无肝损组相比,要显著增长(P<0.05);总胆红素与直接胆红素峰值较无肝损组患儿明显升高,差异均有统计学意义(P<0.05)。PNAC相关因素Logistic回归分析显示,开始喂养时间、氨基酸及脂肪乳提供热卡比率高、SGA、PN持续时间、颅内出血、窒息等为发生PNAC的危险因素,经口摄人热卡高为保护因素。结论肠外营养相关性胆汁淤积的发生与氨基酸及脂肪乳提供热卡比率高、开始喂养时间迟、SGA、PN持续时间长、颅内出血、窒息的发生相关,经口喂养提供热卡高为保护因素。

Objective To investigate the risk factors of preterm parenteral nutrition cholestasis.Methods 91 prematures treated with parenteral nutrition were retrospectively analyzed.The prematures were divided into PNAC group and non-PNAC group according to the occurrence of cholestatic.The nutrition time,fasting time,weight gain and the calories of three major nutrients were observed.Results PNAC group and non-PNAC group of children in The birth weight,asked start feeding,PN duration,fasting time,feeding intolerance,asphyxia,mechanical ventilation,gastrointestinal surgery,sepsis,NEC and SGA of PNAC group and non-PNAC group were statistically significant （P〈0.05）.The gestational age at birth,pneumonia,intracranial hemorrhage and patent ductus arteriosus of PNAC group and nonPNAC group were not statistically significant （P〉0.05）.The liver damage associated with cholestasis duration of PNAC group was significantly increased （P〈0.05）.Logistic regression analysis showed start feeding time,amino acids and high ratio of fat emulsion provided caloric,SGA,PN duration,intracranial hemorrhage and asphyxia were the risk factors of PNAC.The oral high caloric intake was a protective factor.Conclusion Parenteral nutrition-related cholestasis occurs with amino acids and fat emulsion to provide a high caloric ratio,start feeding time later,SGA,PN duration,intracranial hemorrhage,asphyxia related to oral feeding to provide for the protection of high caloric factor.