极低出生体重儿肠外营养相关性胆汁淤积高危因素分析

目的：胆汁淤积是婴儿肠外营养最常见的并发症，本研究旨在调查极低出生体重儿长期肠外营养相关性胆汁淤积的高危因素。方法：回顾性分析2006年8月至2011年12月在重症监护室住院且肠外营养时间大于2周的极低出生体重儿204例，使用营养液前后定期检测肝功能，发生胆汁淤积的观察组和未发生胆汁淤积的对照组进行单因素及多因素分析。结果：204例极低出生体重儿发生胆汁淤积46例（22.5%）；单因素分析显示经鼻持续正压通气（CPAP）、呼吸衰竭、呼吸窘迫综合征、支气管肺发育不良及早产儿视网膜病在观察组的比例明显高于对照组；另外，与对照组相比，观察组出生体重低、吸氧时间长、第一次开奶时间晚、禁食时间长、肠外营养持续时间长、总氨基酸和总脂肪的摄入量高。Logistic回归分析显示禁食时间（OR:1.115,95%CI： 1.031~1.207）是胆汁淤积的高危因素。结论：胆汁淤积的发生是多因素的，危重儿尽早开展肠内营养，减少肠外营养时间，降低胆汁淤积的发生。

High-risk factors for parenteral nutrition-associated cholestasis in very low birth weight infants

Objective To investigate the high-risk factors for parenteral nutrition-associated cholestasis(PNAC),which is the most common complication of parenteral nutrition for infants,in very low birth weight infants(VLBWIs).Methods Retrospective analysis was performed on the clinical and laboratory data of 204 VLBWIs who received parenteral nutrition for over 2 weeks in the neonatal intensive care unit from August 2006 to December 2011.The infants′liver function was evaluated periodically before and after Parenteral nutrition.Univariate analysis and multivariate analysis were performed in the observation(PNAC) and control(without PNAC) groups.Results PNAC occurred in 46(22.5%) of the 204 VLBWIs.Univariate analysis showed that continuous positive airway pressure(CPAP) ventilation,respiration failure,respiratory distress syndrome(RDS),bronchopulmonary dysplasia(BPD) and retinopathy of prematurity(ROP) were significantly increased in the observation group compared with the control group.The observation group had lower birth weights,longer duration of ventilation,later breast feeding beginning,longer duration of fasting,longer duration of parenteral nutrition,and higher cumulated amino acid and lipid emulsion intake.Logistic regression analysis revealed that duration of fasting was a high-risk factor for PNAC(OR=1.115,95%CI: 1.031-1.207).Conclusions Many risk factors are associated with PNAC.Early enteral nutrition and short duration of parenteral nutrition are helpful in preventing the incidence of PNAC in VLBWIs.