论文部分内容阅读
目的回顾分析极低出生体质量儿(VLBWI)肠外营养相关性胆汁淤积(PNAC)的发病率和危险因素。方法对2006年1月-2008年12月在南京儿童医院NICU接受肠外营养(PN)支持超过14d的64例VLBWI的临床资料进行回顾分析,了解PNAC的发病率;并按PNAC的有无进行分组,对2组的临床资料进行分析比较,并应用Logistic回归模型分析PNAC的危险因素。结果 64例VLBWI中10例发生PNAC,发生率15.63%。PNAC组胎龄为(31.54±2.67)周,体质量增长(12.14±8.44)g.d-1,均小于无PNAC组患儿[(33.30±2.01)周,(17.66±4.36)g.d-1](Pa=0.003)。PNAC组患儿住院天数(50.30±32.15)d、PN持续时间(35.00±12.12)d、全静脉营养时间(9.44±8.52)d、氨基酸累计用量(57.62±25.25)g.kg-1、脂肪乳累计用量(55.23±30.60)g.kg-1,均高于无PNAC组。PNAC组先天性心脏病的发病率为30.00%,高于非PNAC组的5.56%,差异有统计学意义(P=0.044)。2组患儿的性别、日龄、出生体质量、PN开始日龄、氨基酸和脂肪乳日用量及感染、窒息、颅内出血、机械通气、坏死性小肠结肠炎的发生率比较差异均无统计学意义。Logistic回归分析示:PN持续时间(OR=0.87,95%CI0.79～0.96,P=0.005)和合并先天性心脏病(OR=39.44,95%CI2.18～714.24,P=0.013)是PNAC的危险因素。结论胎龄越小,全静脉营养时间越长、PN持续时间越长,越易发生PNAC。合并先天性心脏病的患儿使用静脉营养时更易发生PNAC。尽早肠内喂养,缩短PN时间,是降低PNAC的重要措施。
Objective To review the incidence and risk factors of parenteral nutrition-associated cholestasis (VLAC) in very low birth weight infants (VLBWI). Methods The clinical data of 64 VLBWI patients who underwent parenteral nutrition (PN) support in NICU of Nanjing Children’s Hospital from January 2006 to December 2008 were retrospectively analyzed to find out the incidence of PNAC. According to the presence or absence of PNAC The clinical data of two groups were analyzed and compared, and the risk factors of PNAC were analyzed by Logistic regression model. Results PNAC occurred in 10 of 64 VLBWI cases, with a rate of 15.63%. The PNAC group had a gestational age of (31.54 ± 2.67) weeks and a weight gain of (12.14 ± 8.44) gd-1, which were all less than those in the PNAC group [(33.30 ± 2.01) weeks, (17.66 ± 4.36) gd -1] = 0.003). The duration of hospital stay (50.30 ± 32.15) days, PN duration (35.00 ± 12.12) days, total parenteral nutrition time (9.44 ± 8.52) days, total amino acid accumulation (57.62 ± 25.25) g.kg-1, The cumulative dose (55.23 ± 30.60) g.kg-1, were higher than those without PNAC group. The incidence of congenital heart disease in PNAC group was 30.00%, which was higher than that in non-PNAC group (5.56%), the difference was statistically significant (P = 0.044). There was no significant difference in the incidence of infection, asphyxia, intracranial hemorrhage, mechanical ventilation and necrotizing enterocolitis between the two groups in terms of sex, age, birth weight, PN starting day, amino acid and fat emulsion daily intake significance. Logistic regression analysis showed that PN duration (OR = 0.87, 95% CI 0.79-0.96, P = 0.005) and concomitant congenital heart disease (OR = 39.44, 95% CI 2.18-714.24, P = 0.013) Risk factors. Conclusions The smaller the gestational age, the longer the whole vein nutrition, the longer PN duration, the more prone to PNAC. PNAC is more likely to occur when using intravenous nutrition in children with congenital heart disease. Enteral feeding as soon as possible to shorten the PN time is an important measure to reduce PNAC.