不同胎龄早产儿肠外营养相关性胆汁淤积发病因素对比  

Comparative analysis of the incidence factors of parenteral nutrition associated cholestasis in premature infants of different gestational ages

作　　者：张景 王洪青 樊晓莉 ZHANG Jing;WANG Hongqing;FAN Xiaoli(Department of Clinical Nutrition,Xuzhou Children's Hospital,Xuzhou 221000,China)

机构地区：[1]徐州市儿童医院临床营养科,江苏徐州221000

出　　处：《长春中医药大学学报》2024年第12期1372-1379,共8页Journal of Changchun University of Chinese Medicine

基　　金：江苏省科技项目(JSYGY-2019-404);徐州市儿童医院科研项目(22040431)。

摘　　要：目的针对不同胎龄早产儿肠外营养相关性胆汁淤积(PNAC)的发病因素,分析其共性、特性,制定相应的防治措施。方法回顾性选择接受肠外营养(PN)支持14 d以上的早产儿449例,根据胎龄分为超、极早产儿196例与中、晚期早产儿253例,根据研究对象是否发生胆汁淤积分为PNAC组和非PNAC组,分别比较超、极早产儿与中、晚期早产儿临床资料,分析超、极与中、晚期早产儿PNAC发生危险因素,比较超、极与中、晚期早产儿PNAC发病因素区别与联系。结果449例早产儿中116例发生PNAC,发生率为25.84%,其中超、极早产儿PNAC发生率为36.73%,中、晚期早产儿发生率为17.00%。早产儿PNAC发生的共同危险因素:PN持续氨基酸、脂肪乳及葡萄糖使用时长、葡萄糖累计剂量、PN热卡摄入量、住院时间、开始全肠内喂养时间、喂养不耐受发生率、外周静脉置入中心静脉导管(PICC)持续时间;不同危险因素:超、极早产儿为禁食时间、开奶时间、呼吸机持续时间、败血症发生率,中、晚期早产儿为新生儿坏死性小肠结肠炎、类固醇应用率,胎龄、出生体质量、益生菌应用率是中、晚期早产儿PNAC保护因素,PNAC组和非PNAC组比较,差异均有统计学意义(P<0.05)。结论禁食时间越长,感染发生率越高,PN使用时间越长,葡萄糖累计剂量、PN热卡摄入量越高,发生PNAC的概率越大。做好围产期保健、减少早产发生、尽早开始肠内营养、缩短肠外营养支持时间和防治感染是降低PNAC的重要措施。Objective To analyze the common and specific characteristics of parenteral nutrition associated cholestasis(PNAC),and to develop corresponding prevention and treatment measures for this disease according to the pathogenic factors of this disease in premature infants of different gestational ages.Methods 449 premature infants who received parenteral nutrition(PN)support for more than 14 days were retrospectively selected and divided into ultra premature and extremely premature infants(n=196)and mid and late term premature infants(n=253)according to gestational age.These premature infants were divided into the PNAC group and the non PNAC group based on whether the research subjects had cholestasis.The clinical data of ultra premature and extremely premature infant and mid and late term premature infant were compared separately,and the risk factors for the occurrence of PNAC in ultra premature and extremely premature infant,and mid and late term premature infant were analyzed,and the differences and connections in the pathogenic factors of PNAC between ultra premature and extremely premature infant and mid and late term premature infant were compared.Results Among 449 premature infants,116 cases developed PNAC,with an incidence of 25.84%.Among them,the incidence of PNAC in ultra premature and extremely premature infants was 36.73%,and the incidence in mid and late term premature infants was 17.00%.The common risk factors for PNAC included the duration of continuous use of amino acids,fat emulsion,and glucose in PN,cumulative glucose dose,PN calorie intake,length of hospital stay,timing of initiation of enteral feeding,incidence of feeding intolerance,and duration of periperally inserted central catheter(PICC);Different risk factors included fasting time,milk opening time,duration of ventilator,and incidence of sepsis in ultra premature and extremely premature infants,and necrotizing enterocolitis in newborns and steroid use rate in mid and late term premature infants,while gestational age,birth weight,and probiotic

关 键 词：肠外营养 胆汁淤积 危险因素 早产儿 

分 类 号：R722[医药卫生—儿科]