早产儿胃肠外营养相关性胆汁淤积的影响因素分析

Influencing factors of parenteral nutrition associated cholestasis in preterm infant

目的分析影响早产儿胃肠外营养(PN)相关性胆汁淤积的相关因素,为临床干预提供理论依据。方法回顾性分析自2010年1月至2014年4月在佛山市南海区第二人民医院进行PN治疗的146例早产儿相关资料,按照是否发生胆汁淤积分为对照组(未出现胆汁淤积,n=110例)与观察组(出现胆汁淤积,n=36例),比较两组患者出生体重、PN持续时间、禁食时间、住院时间、PN营养液配比、感染、抗生素、机械通气等情况。结果两组患儿出生体重、PN持续时间、禁食时间、糖热卡比、氨基酸热卡比、脂肪乳酸热卡比、奶热卡比、总热卡比较差异有统计学意义(t值分别为5.469、12.921、14.802、8.156、9.217、10.108、19.982、14.698,均P<0.05);感染发生率及机械通气率比较差异有统计学意义(X^2值分别为4.105、4.891,均P<0.05)。多重逐步进入Logistic分析,结果表明PN持续时间长(OR=2.147,95%CI:1.040~3.807),禁食时间长(OR:2.751,95%CI:1.970~4.408)、高葡萄糖热卡比(OR:2.433,95%CI:1.583~3.901)、高脂肪乳热卡比(OR=2.907,95%CI:2.072~5.833)、高氨基酸热卡比(OR=2.779,95%CI:2.018~4.540)、机械通气(OR=1.511,95%CI:1.067~3.908)及感染(OR=1.275,95%CI:1.021~3.460)是早产儿胃肠外营养相关性胆汁淤积的危险性因素,而高出生体重(OR=0.672,95%CI:0.070~0.759)则为保护性因素。结论早产儿胆汁淤积危害患儿的生命健康,临床医师在对早产儿进行PN时应控制早产儿感染、机械通气的使用、早日开奶,减少PN持续时间,且注意PN营养液的合理配比。

Objective To analyze the related factors of parenteral nutrition associated cholestasis in preterm infant and to provide theoretical basis for clinical intervention .Methods Retrospective analysis was conducted on hospitalization data of 146 preterm infants receiving parenteral nutrition （PN） in Second People’s Hospital of Nanhai District during January 2010 to April 2014.The cases were divided into control group （without cholestasis, n=110） and observation group （cholestasis, n=36）, and they were compared in birth weight, PN duration, fasting time, hospitalization length, PN nutrient solution ratio, infection, antibiotics and mechanical ventilation .Results There were significant differences between two groups in birth weight , PN duration, fasting time, sugar calories ratio, amino acid calories ratio, fat lactic acid calories ratio, milk calories ratio, and total calories ratio （t value was 5.469, 12.921, 14.802, 8.156, 9.217, 10.108, 19.982 and 14.698, respectively, all P〈0.05）.The differences in infection incidence and mechanical ventilation rate were significant between two groups （χ2 value was 4.105 and 4.891, respectively, both P〈0.05）.Multiple stepwise Logistic analysis showed that long duration of PN （OR=2.147, 95%CI：1.040-3.807）, long fasting time （OR=2.751,95%CI：1.970-4.408）, high glucose calories ratio （OR=2.433, 95%CI：1.583-3.901）, high fat lactic acid calories ratio （OR=2.907,95%CI：2.072-5.833）, high amino acid calories ratio （OR=2.779,95%CI： 2.018 -4.540）, mechanical ventilation （OR=1.511,95%CI：1.067 -3.908） and infection （OR=1.275, 95%CI：1.021-3.460） were risk factors of premature infants with parenteral nutrition associated cholestasis , while high birth weight was the protective factor （OR=0.672,95%CI：0.070-0.759）.Conclusion Cholestasis in preterm infants threatens life and health of them.Clinicians should control infection , the use of mechanical ventilation , and opening of milk as early as possible .PN duration needs to be reduced and PN nutrient solution should be matched reasonably .