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目的为提高早产儿肠外营养支持的安全性和有效性提供依据。方法 2006年8月至2010年8月两院收入NICU给予7 d以上静脉营养支持的符合入选条件的早产儿178例。随机分为治疗组(85例)和对照组(93例),治疗组为静脉营养联合微量喂养组(微量喂养以输液泵间歇输注法经鼻胃管输注早产儿配方奶5-20 ml/(kg.d)),对照组为全静脉营养组;治疗组再分为肠外营养相关胆汁淤积组(PNAC组)7例和非PNAC组78例,对照组也分为PNAC组18例和非PNAC组75例。比较两组PNAC发生率及相关因素。结果所研究的早产儿PNAC总发生率为14.04%,其中治疗组8.24%,对照组19.35%,治疗组发病率明显下降(OR值为0.260,95%CI为0.087-0.667)。PNAC组的胎龄、出生体重均小于非PNAC组(其中胎龄30±3.2比33±4.1周,P=0.009;OR值为0.827,95%CI0.698-0.981。出生体重1450 g±450 g比1815 g±615 g,P=0.045;OR值1.001,95%CI0.999-1.002,而平均PN持续时间、PN热卡摄入量均大于非PNAC组(其中PN持续时间21.1 d±12.3 d比11.3 d±10.1 d,P=0.003;OR值为1.072,95%CI为1.032-1.112,PN热卡摄入量(302±56)kJ/(kg.d))比252±55 kJ/(kg.d)(1 kcal=4.184 kJ),P=0.022;OR值为1.067,95%CI为1.012-1.123。结论 PNAC的发生与胎龄、低出生体重、PN持续时间长、高热卡有关,静脉营养联合微量喂养较全静脉营养PNAC的发生率低。
Objective To provide evidence for improving the safety and efficacy of parenteral nutritional support in preterm infants. Methods From Aug. 2006 to Aug. 2010, 178 preterm infants who met the inclusion criteria were enrolled in NICU for more than 7 days. (N = 85) and control group (n = 93). The treatment group was intravenous nutrition combined with micro-feeding group (micro-feeding with infusion pump intermittent infusion of nasogastric tube infusion of 5-20 ml / (kg.d)). The control group was all-parenteral nutrition group. The treatment group was further divided into parenteral nutrition-related cholestasis group (PNAC group) 7 cases and non-PNAC group 78 cases. The control group was also divided into PNAC group 18 cases And non-PNAC group of 75 cases. The incidence of PNAC and related factors were compared between the two groups. Results The overall incidence of preterm infants PNAC was 14.04%, of which 8.24% in the treatment group and 19.35% in the control group. The incidence of PNAC in the treatment group decreased significantly (OR = 0.260, 95% CI 0.087-0.667). The gestational age and birth weight of PNAC group were less than that of non-PNAC group (gestational age was 30 ± 3.2 vs 33 ± 4.1 weeks, P = 0.009; OR was 0.827, 95% CI 0.698-0.981; birth weight was 1450 g ± 450 g The mean PN duration and PN caloric intake were higher than those of non-PNAC group (PN duration 21.1 d ± 12.3 d, P = 0.045, OR 1.001, 95% CI 0.99-1.002) Odds ratio was 1.072, 95% CI was 1.032-1.112, PN hot card intake was (302 ± 56) kJ / (kg · d)) than 252 ± 55 kJ / ( kg.d) (1 kcal = 4.184 kJ), P = 0.022; OR was 1.067, 95% CI was 1.012-1.123.Conclusion The occurrence of PNAC is associated with gestational age, low birth weight, PN duration, Intravenous nutrition combined with micro-feeding more than the whole vein nutrition PNAC low incidence.