王榜珍,陈茂琼,张韶明,陈晓霞
WANG Bangzhen,CHEN Maoqiong,ZHANG Shaoming,CHEN Xiaoxia

• 1:贵州医科大学
• 2:贵州医科大学附院新生儿科

摘要(Abstract)：

目的:分析胃肠外营养相关性胆汁淤积症(PNAC)的相关危险因素。方法:生后24 h内入住新生儿重症监护病房(NICU)、胃肠外营养(PN)> 14 d的106例早产儿,按是否发生PNAC分为PNAC组和Non-PNAC组,比较两组早产儿一般资料(性别、胎龄、出生体质量、受孕方式、分娩方式、是否多胎)、肠内营养资料[累积禁食时间、微量喂养开始日龄、奶品及PN 14 d时肠内热卡值、肠外营养资料[氨基酸(AA)、脂肪乳剂(FAT)、葡萄糖(Glu)、铜、锰的起始量及累积量、PN持续时间],分析早产儿发生PNAC的影响因素。结果:106例早产儿PNAC发生率为11. 32%,PNAC组和Non-PNAC组患儿性别、出生体质量、胎龄、分娩方式、多胎,母乳喂养率、开奶量、微量喂养开始日龄、AA、FAT、Glu起始量比较,差异无统计学意义(P> 0. 05); PNAC组试管婴儿比例、累积禁食时间,AA、FAT、Glu、铜、锰累积量及PN热卡累积量高于Non-PNAC组,PN14 d时肠内热卡值低于Non-PNAC组,差异有统计学意义(P <0. 05); Logistic回归分析结果显示,PN持续时间是PNAC发生的危险因素(OR> 1),PN14 d肠内热卡值是保护因素(OR <1)。结论:缩短PN持续时间及降低AA、FAT、Glu、铜、锰、PN热卡累积用量,增加PN14 d时肠内营养热卡值,可降低PNAC的发生。
Objective: To analyze the incidence of and risk factors for parenteral nutrition associated cholestasis( PNAC) in preterm infants. Methods: Data of 106 preterm infants who had been admitted to NICU within 24 hours of birth and received parenteral nutrition( PN) for more than 14 days were collected. Subjects were divided into either a PNAC group or a non-PNAC group. General information( sex,gestational age,birth weight,mode of conception,mode of delivery,multiple births),enteral nutrition data and parenteral nutrition data on preterm infants in both groups were compared to analyze the influencing factors of PNAC in preterm infants. Results: The incidence of PNAC in 106 preterm infants was 11. 32%. The gender,birth weight,gestational age,mode of delivery,multiple births,breastfeeding rate,colostrum amount,starting age of micro-feeding,amino acid( AA),FAT,Glucose starting amount were compared between two groups. The difference was not statistically significant( P > 0. 05); The proportion of IVF,the cumulative fasting time,the accumulation of AA,FAT,Glu,and the average daily amount of copper and manganese,in the PNAC group were higher than those in the Non-PNAC group,the intestinal caloric value after receiving PN for 14 days was lower than those in the Non-PNAC group,and the difference was statistically significant( P < 0. 05); Logistic regression analysis showed that PN duration was a risk factor for PNAC,OR > 1,and PN14 days intestinal caloric value was a protective factor,OR < 1. Conclusion: Shorten the PN duration and reduce the cumulative dosage of AA,FAT,Glu,copper,manganese and PN calorie,and increase the caloric value of enteral nutrition at PN14 days,which can reduce the occurrence of PNAC.

关键词(KeyWords)： 早产儿;胃肠外营养;胆汁淤积症;影响因素;回归分析
preterm infants;parenteral nutrition;cholestasis;influencing factors;regression analysis

Abstract:

Keywords:

基金项目(Foundation): 贵州省卫生计生委科学技术基金资助项目

作者(Author): 王榜珍,陈茂琼,张韶明,陈晓霞
WANG Bangzhen,CHEN Maoqiong,ZHANG Shaoming,CHEN Xiaoxia

DOI: 10.19367/j.cnki.1000-2707.2019.02.019

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