早产极低出生体重儿静脉营养胆汁淤积的高危因素分析

目的观察早产极低出生体重儿静脉营养相关胆汁淤积的发生率,并探讨胃肠外营养相关性胆汁淤积(PNAC)的相关高危因素。方法回顾分析本院2011~2013年108例进行静脉营养支持14d以上的早产极低出生体重儿,按是否发生PNAC分成PNAC组及非PNAC组,观察两组有伴窒息、败血症、肺透明膜病(HMD)、坏死性小肠结肠炎(NEC)、支气管肺发育不良(BPD)、动脉导管开放(PDA)等合并症的发生率。结果 PNAC组的胎龄、出生体重均小于非PNAC组,差异有统计学意义(P0.05)。胃肠外营养持续时间、脂肪乳累计用量、氨基酸最大用量、肠道外营养(PN)热卡摄入量大于非PNAC组,差异有统计学意义(P0.05)。开始喂养日龄、体重恢复迟于非PNAC组,且合并症发生机率增大。结论 PNAC发生与胎龄小、出生体重低、开奶时间迟、大剂量使用氨基酸和脂肪乳、PN热卡高、胃肠外营养时间长,有无并发症有关。

Analysis of risk factors of parenteral nutrition associated cholestasis in very low birth weight infants

Objective To investigate the incidence of parenteral nutrition associated cholestasis （PNAC） in very low birth weight infants （VLBWI） and discuss the risk factors of PNAC. Methods The 108 VLBWI with intravenous nutrition treatment for more than 14-days were retrospectively reviewed and divided into PNAC group and non-PNAC group. The incidence of complications including asphyxia, septicemia, hyaline membrane disease （HMD）, necrotizing enterocolitis （NEC）, bronchi pulmonary dysphasia （BPD）, patent ductus arteriosus（ PDA） between two groups were compared. Results There was less average gestational age and lower birth weight of PNAC group than those of the non-PNAC group. Prenteral nutrition duration, intralipid accumulative dosage, amino acids dosage, PN calorie intake were found higher in PNAC group. The time to start enteric feeding and daily weight gain were delayed in the PNAC group with the higher incidence of complications. Conclusion The incidence of PNAC was associated with small gestational age, low birth weight, later enteric feeding, large doses of amino acids and intralipid intake, high PN calorie intake, long duration of parenteral nutrition and complications of prematurity.