两种静脉脂肪乳剂对早产儿静脉营养相关胆汁淤积的影响

目的分析鱼油脂肪乳、大豆油脂肪乳对接受长期静脉营养早产儿胆汁淤积发生的影响。方法对61例监护室住院早产新生儿的临床资料进行回顾性分析。根据临床静脉营养脂肪乳选择分为3组：豆油组26例、鱼油组20例、无脂肪乳组15例，分析3组患儿基本情况和静脉营养使用情况间的差异以及影响2个月时血清直接胆红素水平的因素。结果胆汁淤积的发生率13%，无脂肪乳组无胆汁淤积发生，豆油组和鱼油组胆汁淤积发生情况无统计学差异。回归分析示脂肪乳总量和开奶时间是生后2个月时血清直接胆红素水平的影响因素。结论脂肪乳的使用是导致胆汁淤积发生的一个重要因素，大豆油和鱼油对胆汁淤积发生的影响无统计学差异，开奶时间推迟会使患儿血直接胆红素水平升高。

Impact of two kinds of intravenous emulsions on occurrence of cholestasis in premature infants with parenteral nutrition

Objective To assess the impact of two kinds intravenous emulsions on the occurrence of cholestasis in premature infants receiving long-term parenteral nutrition. Methods The clinical data of 61 premature infants admitted in neonatal unit of our hospital from 2010 to 2013 were retrospectively analyzed. Among them 26 infants received intravenous soybean oil-based lipid emulsions (Baxter), 20 infants received fish oil-based lipid emulsions (Omegaven) and 15 infants did not receive any intravenous emulsions. The liver function was examined at 2 months of age and the factors affecting serum direct bilirubin levels were analyzed in 3 groups. Results The overall incidence of cholestasis was 13% , there was no significant difference in the incidence rate of cholestasis between soybean emulsion group and fish oil emulsion group; no case of cholestasis was detected in infants not receiving intravenous emulsions. Regression analysis showed that total fat emulsion intake and the time starting milk feeding were factors influencing direct bilirubin levels. Conclusion Both soybean oil and fish oil emulsions may causes cholestasis in premature infants receiving parenteral nutrition; and delayed start of milk feeding would raise the blood direct bilirubin level.