新生儿胃肠外营养相关性胆汁淤积症的危险因素分析

Risk Factors Analysis of Neonatal Parenteral Nutrition Related Cholestasis

目的:调查新生儿接受胃肠外营养(PN)后发生胃肠外营养相关性胆汁淤积症(PNAC)的患病率,并分析其危险因素,为新生儿PNAC的预防和干预提供参考依据。方法:选取2018年3月—2020年12月期间江苏省妇幼保健院收治的289例接受PN的新生儿作为研究对象,根据是否发生PNAC分为2组,并回顾性分析2组新生儿的一般临床资料、肠内营养以及PN情况,探讨影响PNAC发生的危险因素。结果:289例接受PN的新生儿中有36例发生PNAC,发生率12.46%。2组新生儿的胎龄、出生体质量、感染、禁食时间、PN总持续时间、脂肪乳累计量、氨基酸累计量、葡糖糖累计量、PN 14 d静脉热卡值和PN热卡累积量等的比较差异有统计学意义(P<0.05)。Logistic多因素分析结果表明,新生儿感染、禁食时间、PN总持续时间、脂肪乳累计量、氨基酸累计量以及PN热卡累积量是新生儿接受PN后发生PNAC的主要危险因素。结论:积极预防及控制新生儿感染、尽早开始肠内喂养和尽量缩短PN持续时间,以及降低氨基酸、脂肪乳、PN热卡等累积用量,可明显减少新生儿PNAC的发生。

Objective To investigate the prevalence of parenteral nutrition related cholestasis(PNAC)in neonates after receiving parenteral nutrition(PN),and to analyze the risk factors,and to provide reference for prevention and intervention of PNAC.Method Totally289 newborns who received PN in Jiangsu Women and Children Health Hospital were selected as the subjects of study from March 2018 to December 2020.According to whether PNAC occurred,they were divided into two groups.The general clinical data,enteral nutrition and PN status of the two groups were analyzed retrospectively to explore the risk factors affecting the occurrence of PNAC.Result Among 289 newborns who received PN,36 cases(12.46%)had PNAC.The difference of gestational age,body mass,infection,fasting time,PN duration,fat milk accumulation,amino acid accumulation,glucose accumulation,PN 14 d and PN heat card accumulation were statistically significant(P<0.05).The results of logistic multivariate analysis showed that the main risk factors of PNAC were infection,fasting time,PN duration,fat milk accumulation,amino acid accumulation and PN heat card accumulation.Conclusion The prevention and control of neonatal infection,the early start of enteral feeding and the shortening of PN duration as soon as possible,as well as the decrease of the accumulation of amino acids,fat milk,PN heat card,are useful measures to significantly reduce the occurrence of PNAC in newborns.