高危早产儿肠外营养相关性胆汁淤积的危险因素及转归分析

目的 探讨极低和（或）极早早产儿肠外营养相关性胆汁淤积（parenteral nutrition associated cholestasis，PNAC）发生的危险因素及疾病转归。 方法 选择早产儿100例,均于生后24 h内入住新生儿重症监护病房，接受肠外营养（parenteral nutrition,PN）≥14 d，胎龄＜32周和(或)出生体重＜1 500 g。依据实验室结果将其分为PNAC组40例和非PNAC组60例，比较2组临床资料，分析PNAC发生的危险因素。 结果 PNAC组新生儿败血症、NEC发生率、中/长链脂肪乳使用率高于非PNAC组，出生胎龄小于非PNAC组，PN持续时间、脂肪乳使用时间、葡萄糖使用时间、禁食时间、抗生素使用时间长于非PNAC组，葡萄糖累积用量高于非PNAC组，差异有统计学意义（P＜0.05）。多元Logistic回归分析结果显示，新生儿败血症、使用中/长链脂肪乳是PNAC发生的独立危险因素（P＜0.05）。PNAC发生时间为PN后22.0（11.0）d，PN后38.0（21.0）d 血清直接胆红素（direct bilirubin，DBIL）达到峰值，生后47.5（38.0）d后恢复正常，PNAC组发生肝功能损害8例，发生率为20%，无发生肝功能衰竭病例。 结论 PNAC是高危早产儿的常见并发症之一，减少不必要的禁食，缩短PN持续时间，预防感染及NEC发生，优化静脉营养成分对预防PNAC的发生及减轻其严重程度具有积极作用。

Risk factors and outcomes of parenteral nutrition-associated cholestasis in high-risk preterm infants

Objective To investigate the risk factors of parenteral nutrition-associated cholestasis (PNAC) in very low birth weight and/or very preterm infants and to analyze the outcomes of the infants.Methods One hundred premature infants were selected, who were admitted to the neonatal intensive care unit (NICU) within 24 h after birth, received parenteral nutrition (PN) ≥14 d, and had gestational age ＜ 32 weeks and/or birth weight ＜1 500 g. According to the laboratory results, they were divided into PNAC group (n=40) and non-PNAC group (n=60). The clinical data of the two groups were compared and the risk factors of PNAC were analyzed.Results The incidence of neonatal septicemia, neonatal necrotizing enterocolitis(NEC) and the use rate of medium/long chain fat emulsion in PNAC group were higher than those in non-PNAC group; The birth age was lower than that in non-PNAC group, while the duration of PN, the use time of fat emulsion, the use time of glucose, fasting time, and the use time of antibiotics were longer than those in non-PNAC group, and the cumulative use of glucose was higher than that in non-PNAC group, with statistically significant difference (P＜0.05). Multiple logistic regression analysis showed that neonatal septicemia and use of medium/long chain fat emulsion were independent risk factors for PNAC (P＜0.05). The occurrence time of PNAC was 22.0 (11.0) d after PN, and the serum direct bilirubin (DBIL) reached its peak at 38.0（21.0） d after PN, and returned to normal at 47.5(38.0) d after birth. There were 8 cases of liver function damage in PNAC group, with the incidence of 20%, and no liver failure occurred.Conclusion PNAC is one of the common complications of high-risk premature neonates. To reduce unnecessary fasting, shorten the duration of PN, prevent nosocomial infection and NEC, and optimize parenteral nutrition composition would play a positive role in preventing PNAC and reducing its severity.