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目的探讨低出生早产儿肠外营养相关性胆汁淤积(PNAC)的危险因素。方法对东南大学附属中大医院新生儿重症监护病房在2009年10月至2014年10月进行肠外营养支持(>14 d)治疗的234例早产儿资料进行回顾性分析,并根据患儿是否发生胆汁淤积分为PNAC组与非PNAC组。并比较两组患儿一般情况及接受肠外营养支持治疗的时间。结果 PNAC组与非PNAC组患儿肠外营养(PN)支持治疗持续时间[(24.59±9.70)d vs(21.36±7.05)d]、新生儿窒息发生率(48.70%vs 31.40%)、颅内出血发生率(23.10%vs 10.80%)差异均有统计学意义(P均<0.05),而在肺炎发生、患儿出生胎龄、体重、败血症、坏死性小肠结肠炎、电解质紊乱等方面差异无统计学意义(P均>0.05)。结论肠外营养相关性PNAC的发生与PN持续时间长、颅内出血、窒息的发生相关。临床工作中应积极控制早产、感染,控制原发病,可能的情况下,减少PN时间,加强对早产儿PN期间肝功能、胆红素指标的严密监测。
Objective To investigate the risk factors of parenteral nutrition-associated cholestasis (PNAC) in premature infants with low birth weight. Methods The data of 234 preterm infants who underwent parenteral nutrition support (> 14 days) from 2009 neonatal intensive care unit affiliated to Affiliated Zhongda Hospital of Southeast University from October 2009 to October 2014 were analyzed retrospectively. Cholestasis was divided into PNAC group and non-PNAC group. The general condition of the two groups and the time of parenteral nutrition support were compared. Results The duration of parenteral nutrition (PN) supportive therapy in PNAC group and non-PNAC group [(24.59 ± 9.70) d vs (21.36 ± 7.05) d], neonatal asphyxia (48.70% vs 31.40%), intracranial hemorrhage (P <0.05). There was no statistical difference in the incidence of pneumonia, gestational age, weight, sepsis, necrotizing enterocolitis and electrolyte imbalance Significance (P> 0.05). Conclusion The occurrence of parenteral nutrition-related PNAC is associated with long duration of PN, intracranial hemorrhage and apnea. Clinical work should be actively controlled premature birth, infection, control of the primary disease, when possible, reduce the PN time, strengthen the PN during preterm children with liver function, bilirubin indicators closely monitored.