极/超低出生体重儿胃肠外营养相关性胆汁淤积的临床特点分析

Analysis of clinical characteristics of parenteral nutrition associated cholestasis in very/extremely low birth weight infants

目的探讨对极低出生体重儿/超低出生体重儿(VLBWI/ELBWI)采取胃肠外营养(PN)治疗后,发生胃肠外营养相关性胆汁淤积(PNAC)的影响因素。方法选择2017年7月至2019年7月,于广西壮族自治区妇幼保健院诊治的88例胎龄<32周的VLBWI/ELBWI为研究对象。根据住院期内是否发生PNAC,将其分为PNAC组(n=42,发生PNAC)及非PNAC组(n=46,未发生PNAC)。回顾性分析2组患儿临床病例资料。采用t检验及χ^(2)检验,对2组患儿一般临床资料,PN及肠内营养(EN)支持及并发症情况进行比较,并对差异具有统计学意义的指标,采用多因素非条件logistic回归分析,对VLBWI/ELBWI采取PN治疗后发生PNAC的独立影响因素进行分析。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。结果①单因素分析结果显示:2组患儿胎龄、母乳喂养比例、PN持续时间、败血症及喂养不耐受发生率比较,差异均有统计学意义(P<0.05)。②多因素非条件logistic回归分析结果显示:PN持续时间长(OR=1.423,95%CI:1.151~1.758,P=0.001),合并败血症(OR=5.067,95%CI:1.355~18.951,P=0.016),喂养不耐受(OR=7.258,95%CI:2.659~19.816,P<0.001),均为VLBWI/ELBWI给予PN后发生PNAC的独立危险因素;而母乳喂养(OR=0.149,95%CI:0.048~0.458,P=0.001)则为独立保护因素。结论对VLBWI/ELBWI采用PN持续时间长,发生喂养不耐受及感染等,更易发生PNAC。同时,应重视对VLBWI/ELBWI的母乳喂养,以降低PNAC发生率。

Objective To investigate the influencing factors of parenteral nutrition associated cholestasis(PNAC)in very-/extremely-low birth weight infant(VLBWI/ELBWI)after parenteral nutrition(PN)treatment.Methods From July 2017 to July 2019,a total of 88 VLBWI/ELBWI(gestational age<32 weeks)hospitalized in Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region were selected as research objects.According to whether PNAC occurred or not during hospitalization period,they were divided into PNAC group(n=42,complicated with PNAC)and non-PNAC group(n=46,without PNAC).Clinical data of subjects of two groups were retrospectively analyzed.The general clinical data,PN and enteral nutrition(EN)supports treatment and their related complications were compared between two groups by t test and chi-square test.And for indicators with statistical significance,multivariate unconditional logistic regression analysis was performed to analyze independent influencing factors of PNAC occurrence in VLBWI/ELBWI after PN treatment.The procedures followed in this study was in line with the World Medical Association Declaration of Helsinki revised in 2013.Results①Univariate analysis showed that there were significant differences in gestational age,breast feeding ratio,PN duration,incidence of sepsis and feeding intolerance between two groups(P<0.05).②Multivariate unconditional logistic regression analysis showed that long duration of PN(OR=1.423,95%CI:1.151-1.758,P=0.001),complicated with sepsis(OR=5.067,95%CI:1.355-18.951,P=0.016)and feeding intolerance(OR=7.258,95%CI:2.659-19.816,P<0.001)were independent risk factors of PNAC occurrence in VLBWI/ELBWI after given PN,on the contrary,breast feeding(OR=0.149,95%CI:0.048-0.458,P=0.001)was an independent protective factor.Conclusions When VLBWI/ELBWI with long duration of PN,feeding intolerance and infection,etc.,are more prone to PNAC.At the same time,attention should be paid to breast feeding of VLBWI/ELBWI to reduce PNAC complication.