极早和超早产儿胃肠外营养相关性胆汁淤积症危险因素分析  

Retrospective Analysis of Risk Factors for Parenteral Nutrition⁃associated Cholestasis in Extremely and Ultra Premature Infants

作　　者：张景 樊晓莉 王洪青 ZHANG Jing;FAN Xiaoli;WANG Hongqing(Department of Nutriology,Xuzhou Children's Hospital Affiliated to Xuzhou Medical University,Xuzhou,Jiangsu 221000,China)

机构地区：[1]徐州医科大学附属徐州儿童医院营养科,江苏徐州221000

出　　处：《转化医学杂志》2024年第8期1183-1188,共6页Translational Medicine Journal

基　　金：徐州市儿童医院科研项目(22040431)。

摘　　要：目的 探讨极早和超早产儿胃肠外营养相关性胆汁淤积症(PNAC)的危险因素并进行分析。方法 回顾性分析2018年1月至2022年12月收治的196例接受肠外营养支持> 14 d的极早产儿102例、超早产儿94例。根据研究对象是否发生PNAC分为PNAC组和非PNAC组,比较2组临床资料,采用多因素logistic回归分析发生PNAC的危险因素。结果 196例极早产儿和超早产儿中有72例发生PNAC,发生率为36.73%。与非PNAC组比较,PNAC组住院时间、肠外营养持续时间,氨基酸、脂肪乳、葡萄糖使用时间,经外周中心静脉置管和呼吸机持续时间更长,氨基酸、脂肪乳、葡萄糖、肠外营养热卡累积量高,脓毒症发生率高(P<0.05,P<0.01);与非PNAC组比较,PNAC组使用益生菌比例更低(P<0.01)。多因素logistic回归分析显示,肠外营养持续时间、肠外营养热卡累积量、脓毒症、呼吸机持续时间是极早和超早产儿发生PNAC的危险因素(P<0.05,P<0.01)。结论 肠外营养持续时间和呼吸机持续时间延长、肠外营养热卡累积量上升以及合并脓毒症,会增加极早和超早产儿发生PNAC的风险。合理控制肠外营养支持时间和防治感染是降低极早和超早产儿PNAC的重要措施。Objective To investigate and analyze the risk factors of parenteral nutrition⁃related cholestasis(PNAC)in very early and ultra⁃preterm infants.Methods A total of 196 extremely preterm infants(102 cases)and ultra⁃preterm in⁃fants(94 cases)who received parenteral nutrition support for more than 14 days were retrospectively analyzed from January 2018 to December 2022.According to whether the subjects had PNAC or not,they were divided into PNAC group and non⁃PNAC group.The clinical data of the two groups were compared,and the risk factors of PNAC were analyzed by multivariate logistic regression.Results PNAC occurred in 72 of 196 extremely preterm infants and ultra⁃preterm infants(36.73%).Compared with non⁃PNAC group,PNAC group had longer hospital stay,parenteral nutrition duration,amino acid,fat milk,glucose use time,PICC and ventilator duration,higher accumulation of amino acid,fat milk,glucose,parenteral nutrition heat card,and higher incidence of sepsis(P<0.05,P<0.01).Compared with non⁃PNAC group,the proportion of probiot⁃ics used in PNAC group was lower(P<0.05).Multivariate logistic regression analysis showed that the duration of parenteral nutrition,cumulative dose of parenteral nutrition heat card,sepsis and ventilator duration were risk factors for PNAC in very early and ultra⁃preterm infants(P<0.05).Conclusion Prolonged duration of parenteral nutrition and ventilator duration,increased cumulative use of parenteral nutrition heat cards,and combined sepsis increase the risk of PNAC in very early and ultra⁃preterm infants.Reasonable control of parenteral nutrition support time and prevention of infection are important meas⁃ures to reduce PNAC in very early and ultra⁃premature infants.

关 键 词：胃肠外营养 婴儿 早产 胆汁淤积 危险因素 脓毒症 肠外营养热卡累积用量 呼吸机持续时间 肠外营养持续时间 

分 类 号：R722.6[医药卫生—儿科]