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目的探讨胃肠外营养(PN)中的主要成分对极低出生体重儿胃肠外营养相关性胆汁淤积(PNAC)的影响。方法 对本中心2004—2008年使用14天以上PN极低出生体重儿中的PNAC病例和配对非PNAC病例资料进行回顾性分析(两组在出生体重、胎龄、窒息程度和PN持续时间方面相匹配),比较两组发生PNAC相关因素的差异。结果 PNAC组(12例)在PN应用的1周和2周内平均每日氨基酸摄入量明显高于非PNAC组(24例),分别为(2.5±0.5)g/kg和(2.1±0.4)g/kg(P=0.012)、(2.6±0.4)g/kg和(2.2±0.3)g/kg(P=0.004),PN应用期间两组平均每日氨基酸摄入量分别为(2.3±0.3)g/kg和(2.0±0.4)g/kg,差异无统计学意义(P>0.05);两组在PN应用期间每日平均脂肪和葡萄糖的摄入量差异无统计学意义(P均>0.05)。结论 极低出生体重儿PNAC的发生可能与应用PN前2周内摄入较高剂量的氨基酸有关,因此有必要进行随机双盲对照试验进一步研究。
Objective To investigate the effects of parenteral nutrition (PN) on parenteral nutrition-associated cholestasis (PNAC) in very low birth weight infants. Methods The data of PNAC cases and matched non-PNAC cases in PN very low birth weight children over 14 days from 2004 to 2008 in our center were retrospectively analyzed (birth and weight, gestational age, degree of asphyxia and PN duration were matched in both groups ), Differences in the occurrence of PNAC related factors between the two groups were compared. Results The average daily intake of amino acids in PNAC group (12 cases) within 1 week and 2 weeks after PN administration was significantly higher than that in non-PNAC group (2.5 ± 0.5) g / kg and (2.1 ± 0.4 (P = 0.012), (2.6 ± 0.4) g / kg and (2.2 ± 0.3) g / kg respectively (P = 0.004) .The average daily intake of amino acids in the two groups during PN administration were 0.3) g / kg and (2.0 ± 0.4) g / kg, respectively, with no significant difference (P> 0.05). There was no significant difference in average daily intake of fat and glucose between the two groups > 0.05). Conclusions The occurrence of PNAC in very low birth weight children may be related to the intake of higher doses of amino acids in the first 2 weeks of PN. Therefore, it is necessary to conduct a double-blind randomized controlled trial for further study.