危重症早产儿胃肠外营养相关胆汁淤积的影响因素分析

The influencing factors of parenteral nutrition-associated cholestasis in critically ill premature infants

目的探讨危重症早产儿胃肠外营养(PN)相关胆汁淤积(PNAC)的影响因素。方法选取2017-01~2017-12该院新生儿重症监护室采用静脉营养时间超过14 d早产儿300例作为研究对象,按照是否发生PNAC分为非PNAC组215例和PNAC组85例。比较两组早产儿的临床和营养因素情况,采用非条件二分类Logistic回归分析PNAC的危险因素。结果两组在新生儿感染、贫血及机械通气等方面比较差异有统计学意义(P<0.05)。两组在禁食时间、脂肪乳总量、奶总量及热卡总量等方面比较差异有统计学意义(P<0.05)。多因素分析结果显示,新生儿感染(OR=2.352)、禁食时间长(OR=1.263)、PN持续时间长(OR=1.854)、氨基酸热卡比例高(OR=2.865)、脂肪乳热卡比例高(OR=1.854)是PNAC的危险因素,经口摄入高热卡为保护因素(OR=0.025)。结论新生儿感染、PN持续时间及禁食时间长等因素是早产儿发生PNAC的危险因素。

Objective To explore the influencing factors of parenteral nutrition(PN)-associated cholestasis(PNAC)in critically ill premature infants.Methods Three hundred premature infants over 14 days of gestational age in the Neonatal Intensive Care Unit of Boai Hospital were selected as the study subjects from January 2017 to December 2017.They were divided into non-PNAC group(n=215)and PNAC group(n=85)according to whether or not PNAC occurred.The clinical situations and nutritional factors of the premature infants were compared between the two groups and the risk factors were analyzed by non-conditional Logistic regression analysis.Results There were significant differences in neonatal infections,anemia,mechanical ventilation,fasting time,quantity of total fat and milk,and total calorie between the two groups(P<0.05).Multivariate analysis showed that neonatal infections(OR=2.352),long fasting time(OR=1.263),long duration of PN(OR=1.854)and high proportion of amino acid calorie(OR=2.865),and high proportion of fat milk calorie(OR=1.854)were the risk factors of PNAC.The protective factor was intake of high calorie through mouth(OR=0.025).Conclusion Neonatal infections,long duration of PN and long fasting time are the risk factors of PNAC in premature infants.