不同肠外营养策略对极低出生体重儿肠外营养相关性胆汁淤积发病的影响

目的 探讨不同肠外营养(PN)方案对极低出生体重儿(VLBWI)肠外营养相关性胆汁淤积(PNAC)发病的影响.方法 对2006年9月至2007年8月低营养方案组24例和2007年9月至2008年2月高营养方案组21例VLBWI的资料进行回顾性分析,比较两组PN方案差异对PNAC发病率的影响.高营养方案组再分为PNAC组(8例)和无PNAC组(13例),比较两组间影响PNAC发生的相关因素.结果 低营养方案组和高营养方案组PNAC的发生率分别为12.5%和38.1%(P<0.05);低营养方案组PN应用第1、2周内平均每天氨基酸和脂肪的摄入量分别为(2.0±0.3)g/kg和(2.3±0.2)g/kg,(1.3±0.4)g/kg和(1.6±0.1)g/kg,均低于高营养方案组分别为(2.5±0.4)g/kg和(2.7±0.3)g/kg,(1.7±0.5)g/kg和(2.0±0.1)g/kg],差异有统计学意义(P<0.01).高营养方案组中PNAC组出生体重明显低于无PNAC组,分别为(1275.6±148.8)g和(1404.6±107.6)g,差异有统计学意义(P<0.05).结论 PN第1、2周高营养方案可能会增加VLBWI PNAC的发生,特别是VLBWI中体重较低者.

Effect of different parenteral nutrition strategies on the incidence of parenteral nutrition-associated cholestasis in very low birth weight infants

Objective To explore the effect of different parenteral nutrition (PN) strategies on the incidence of parenteral nutrition-associated cholestasis (PNAC) of very low birth weight infants (VLBWI). Methods Forty-five VLBWI were divided into two groups: 24 cases in low PN group hospitalized from Sep. 2006 to Aug. 2007 and 21 cases in high PN group hospitalized from Sep. 2007 to Feb. 2008. The data of two groups were retrospectively analyzed and the incidences of PNAC were compared. High PN group was subdivided into PNAC group (n=8) and non PNAC group (n= 13). The associated factors with PNAC were analyzed. Results The incidences of PNAC in low PN group and high PN group were 12.5% and 38.1% (P<0. 05), respectively. Average daily intake of amino acid and lipid in the first and the second week of PN in low PN group were (2.0±0.3) g/kg and (2. 3±0. 2) g/kg, (1.3±0. 4) g/kg and (1.6±0. 1) g/kg, lower than those in high PN group (2. 5±0. 4) g/kg and (2.7±0. 3) g/kg,(1.7±0. 5) g/kg and(2.0±0. 1) g/kg](P<0.01). Birth weight of infants in PNAC group was significantly lower than that of non PNAC group (1275.6± 148. 8) g and (1404. 6±107.6) g, P<0. 05]. Conclusions High PN intake in the first 2 weeks of life may increase the incidence of PNAC in VLBWI, especially for those with lower birth weight.