腹腔镜治疗早产儿营养相关性胆汁淤积症的预后影响因素分析  

The prognostic factors of premature infants with nutrition-related cholestasis treated by laparoscopy

作　　者：吴宙光[1] 王斌[1] 左桃燕 陈思琦 付静茹 张文杰 程珍 WU Zhou-guang;WANG Bin;ZUO Tao-yan;CHEN Si-qi;FU Jing-ru;ZHANG Wen-jie;CHENG Zhen(Department of Gene al Surgery,Shenzhen Children's Hospital,Shenzhen 518026,Guangdong,China)

机构地区：[1]深圳市儿童医院普外科,广东深圳518026

出　　处：《广东医学》2023年第5期538-542,共5页Guangdong Medical Journal

基　　金：儿科营养支持团队(NST)发展科研公益项目(xm-2019-000-0114-03);深圳市卫计委“三名工程”资助项目(SZSM201812055)。

摘　　要：目的探讨经腹腔镜胆道冲洗治疗早产儿营养相关性胆汁淤积症的预后影响因素。方法回顾性分析2014年12月至2019年12月新生儿重症监护室行手术治疗营养相关性胆汁淤积症150例患儿的临床情况,将治疗有效患儿分为好转组(35例)和治愈组(104例),比较两组患儿的一般资料,并采用logistic回归分析影响营养相关性胆汁淤积症患儿手术预后的相关因素。结果好转组患儿的胎龄和出生体重低于治愈组(P<0.05)。好转组的病程时长、肠外营养持续时间、禁食时间、确诊时血清总胆红素和直接胆红素值、总热量、氨基酸累积量、脂肪乳累积量、葡萄糖累积量、铜累积量和锰累积量明显高于治愈组(P<0.05)。肠外营养持续时间、确诊时血清总胆红素和直接胆红素、总热量、氨基酸累积量、脂肪乳累积量和铜累积量是营养相关性胆汁淤积症患儿手术预后的独立危险因素。结论缩短肠外营养时间,避免早产儿感染以及降低早产儿肠外营养中氨基酸和脂肪乳等含量,对于提高患儿术后疗效至关重要。Objective To investigate the prognostic factors on laparoscopic biliary irrigation in the treatment of nutrition-related cholestasis in premature infants.Methods The clinical conditions of 150 preterm neonates with nutrition-related cholestasis received surgery in the Neonatal Intensive Care Unit from December 2014 to December 2019 were retrospectively analyzed.The preterm neonates who were effectively treated were divided into the improved group(35 cases)and the cured group(104 cases),and the clinical information of the two groups was compared.Furthermore,logistic regression was used to analyze the related factors affecting the surgical prognosis of preterm neonates with nutrition-related cholestasis.Results The gestational age and birth weight of preterm neonates in the improved group were significantly lower than those in the cured group(P<0.05).The hospital stay,PN duration,fasting time,serum total bilirubin and direct bilirubin levels at diagnosis,total calories,amino acid accumulation,fat milk accumulation,glucose accumulation,copper accumulation and manganese accumulation in the improved group were significantly higher than those in the cured group(P<0.05).In addition,PN duration,serum total bilirubin and direct bilirubin at diagnosis,total calories,amino acid accumulation,fat milk accumulation and copper accumulation were independent risk factors for surgical prognosis in preterm neonates with nutrition-associated cholestasis.Conclusion Shortening parenteral nutrition time,avoiding neonatal infection and reducing the contents of amino acids and fatty milk in parenteral nutrition for preterm infants are of great importance for improving postoperative efficacy.

关 键 词：胆汁淤积症 早产儿 肠外营养 预后因素 

分 类 号：R722.6[医药卫生—儿科] R726.1[医药卫生—临床医学]