多种油脂肪乳在早产儿坏死性小肠结肠炎的临床应用研究

Clinical application of mixed-oil fat emulsion in preterm infants with necrotizing enterocolitis

目的探讨多种油脂肪乳(soybean,medium-chain triglyceride,olive and fish oils,SMOF)在早产儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)的临床应用。方法回顾性分析2017年1月至2022年12月青岛大学附属医院新生儿重症监护室病房收治的早产儿NEC的临床资料,根据住院期间应用脂肪乳的种类分为SMOF组和中长链脂肪乳(medium and long chain triglycerides,MCT/LCT)组,对两组资料进行比较并统计学分析。结果共纳入69例早产儿,SMOF组34例,MCT/LCT组35例。两组总胆红素、间接胆红素、直接胆红素、胆汁酸及γ-谷氨酰基转移酶水平比较差异无统计学意义(P>0.05)。两组甘油三酯、低密度脂蛋白、总胆固醇比较差异无统计学意义(P>0.05)。两组发病急期炎症指标C-反应蛋白、降钙素原以及C-反应蛋白恢复正常时间比较差异无统计学意义(P>0.05)。两组并发症比较包括肠外营养相关性胆汁淤积、支气管肺发育不良、早产儿视网膜病及脑损伤差异无统计学意义(P>0.05)。结论与MCT/LCT相比,应用SMOF的NEC早产儿肝功能指标及炎症指标差异无统计学意义,肠外营养相关性胆汁淤积、支气管肺发育不良、早产儿视网膜病等并发症无明显降低,有必要开展多中心大样本研究。

Objective To investigate the clinical application of multi-oil fat emulsion(SMOF)in preterm infants with necrotizing enterocolitis(NEC).Methods Preterm infants with NEC admitted to the Neonatal Intensive Care Unit in our hospital between January 2017 and December 2022 were retrospectively included.According to the type of fat emulsion used,they were divided into SMOF group and medium and long chain triglycerides(MCT/LCT)group.The data of two groups were compared and analyzed.Results A total of 69 preterm infants were included,34 in the SMOF group and 35 in the MCT/LCT group.There were no significant differences between the two groups in the levels of total bilirubin,indirect bilirubin,direct bilirubin,bile acid andγ-glutamyl transferase(P>0.05).There were no significant differences between the two groups in triglyceride,low density lipoprotein and total cholesterol(P>0.05).There were no significant differences between the two groups in the C reactive protein level,procalcitonin level,and the time to normal C reactive protein(P>0.05).There were no significant differences in incidence of complications between the two groups,including parenteral nutrition-related cholestasis,bronchopulmonary dysplasia,retinopathy of prematurity,and brain injury(P>0.05).Conclusions Compared with MCT/LCT,the application of SMOF did not show significant effect on liver function,inflammation,or incidence of complications(parenteral nutrition-related cholestasis,bronchopulmonary dysplasia and retinopathy of prematurity)in preterm infants with NEC.Multi-center studies with larger sample size are needed for further investigation.