高危早产儿肠外营养相关性胆汁淤积的危险因素及转归分析  

Risk factors and outcomes of parenteral nutrition-associated cholestasis in high-risk preterm infants

作　　者：房军臣 李莉[1] 陈新[1] 蒲伟丛 马莉[1] 邱向利 FANG Jun-chen;LI Li;CHEN Xin;PU Wei-cong;MA Li;QIU Xiang-li(Department of Neonatology,Hebei Children′s Hospital Affiliated to Hebei Medical University,Shijiazhuang 050031,China)

机构地区：[1]河北医科大学附属河北省儿童医院新生儿科,河北石家庄050031

出　　处：《河北医科大学学报》2023年第4期444-449,共6页Journal of Hebei Medical University

基　　金：河北省卫健委青年科技课题(20200644)。

摘　　要：目的 探讨极低和(或)极早早产儿肠外营养相关性胆汁淤积(parenteral nutrition associated cholestasis,PNAC)发生的危险因素及疾病转归。方法 选择早产儿100例,均于生后24 h内入住新生儿重症监护病房,接受肠外营养(parenteral nutrition,PN)≥14 d,胎龄<32周和(或)出生体重<1 500 g。依据实验室结果将其分为PNAC组40例和非PNAC组60例,比较2组临床资料,分析PNAC发生的危险因素。结果 PNAC组新生儿败血症、NEC发生率、中/长链脂肪乳使用率高于非PNAC组,出生胎龄小于非PNAC组,PN持续时间、脂肪乳使用时间、葡萄糖使用时间、禁食时间、抗生素使用时间长于非PNAC组,葡萄糖累积用量高于非PNAC组,差异有统计学意义(P<0.05)。多元Logistic回归分析结果显示,新生儿败血症、使用中/长链脂肪乳是PNAC发生的独立危险因素(P<0.05)。PNAC发生时间为PN后22.0(11.0)d,PN后38.0(21.0)d血清直接胆红素(direct bilirubin,DBIL)达到峰值,生后47.5(38.0)d后恢复正常,PNAC组发生肝功能损害8例,发生率为20%,无发生肝功能衰竭病例。结论 PNAC是高危早产儿的常见并发症之一,减少不必要的禁食,缩短PN持续时间,预防感染及NEC发生,优化静脉营养成分对预防PNAC的发生及减轻其严重程度具有积极作用。Objective To investigate the risk factors of parenteral nutrition-associated cholestasis(PNAC)in very low birth weight and/or very preterm infants and to analyze the outcomes of the infants.Methods One hundred premature infants were selected,who were admitted to the neonatal intensive care unit(NICU)within 24 h after birth,received parenteral nutrition(PN)≥14 d,and had gestational age<32 weeks and/or birth weight<1500 g.According to the laboratory results,they were divided into PNAC group(n=40)and non-PNAC group(n=60).The clinical data of the two groups were compared and the risk factors of PNAC were analyzed.Results The incidence of neonatal septicemia,neonatal necrotizing enterocolitis(NEC)and the use rate of medium/long chain fat emulsion in PNAC group were higher than those in non-PNAC group;The birth age was lower than that in non-PNAC group,while the duration of PN,the use time of fat emulsion,the use time of glucose,fasting time,and the use time of antibiotics were longer than those in non-PNAC group,and the cumulative use of glucose was higher than that in non-PNAC group,with statistically significant difference(P<0.05).Multiple logistic regression analysis showed that neonatal septicemia and use of medium/long chain fat emulsion were independent risk factors for PNAC(P<0.05).The occurrence time of PNAC was 22.0(11.0)d after PN,and the serum direct bilirubin(DBIL)reached its peak at 38.0(21.0)d after PN,and returned to normal at 47.5(38.0)d after birth.There were 8 cases of liver function damage in PNAC group,with the incidence of 20%,and no liver failure occurred.Conclusion PNAC is one of the common complications of high-risk premature neonates.To reduce unnecessary fasting,shorten the duration of PN,prevent nosocomial infection and NEC,and optimize parenteral nutrition composition would play a positive role in preventing PNAC and reducing its severity.

关 键 词：胆汁淤积 婴儿 早产 危险因素 

分 类 号：R722[医药卫生—儿科]