早产儿胃肠外营养相关性胆汁淤积的危险因素分析及防治措施

Analysis for risk factors and prevention measures of parenteral nutrition-associated cholestasis in preterm infant

目的:探讨早产儿胃肠外营养相关性胆汁淤积(PNAC)的危险因素和有效的防治措施。方法:将299例行PN治疗的早产儿根据是否为PNAC分为PNAC组(n=32例)和非PNAC组(n=267例)。比较两组早产儿的临床和营养因素,采用Logistic回归分析危险因素。结果:两组早产儿在胎龄、出生时体重、贫血、新生儿感染等方面存在显著性差异(P<0.05);两组早产儿在禁食时间,氨基酸、脂肪乳和乳类的热量比,每天总热量和喂养困难等方面亦存在显著性差异(P<0.05)。多因素分析结果显示,禁食时间长、氨基酸和脂肪乳提供热量比率高、胎龄低、新生儿感染均为发生PNAC的危险因素(P<0.05)。乳类提供热量比率高则是保护性因素(P<0.05)。结论:禁食时间长、氨基酸与脂肪乳提供热量比率高、胎龄低、新生儿感染等为PNAC的危险因素。依此制订有效的防治措施,可明显降低PNAC的发生率。

Objective ： To investigate the risk factors and prevention measures of parenteral nutrition-associated cholestasis in preterm infant （PNAC）, and summarize effective control measures. Methods ： 299 premature children with routine PN treatment were divided into PNAC group （ n = 32） and non- PNAC group （n = 267 patients） according to whether they were PNAC or not. The clinical and nu- tritional factors of preterm infant were compared using Logistic regression analysis of risk factors. Results ： The two groups showed obvious difference in aspects of gestational age, birth weight, anemia, neonatal infections （P 〈 0.05 ）. There were significant differences between two groups in nutritional factors such as time of fasting, amino acids calorie ratio, milk calorie ratio, total daily calories and feeding difficulties （P 〈 0.05 ）. The multivariate analysis showed that long fasting time, amino acids and fat milk with high caloric ratio , low gestational age , neonatal infection were risk factors of PNAC （ P 〈 0.05 ）, and milk with high caloric ratio was a protective factor （ P 〈 0.05 ）. Conclusion ： The risk factors of PNAC are long fasting, amino acids and fat milk with high caloric ratio, low gestational age and neonatal infection.