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目的探讨早产儿发生胃肠外营养相关性胆汁淤积(PNAC)的危险因素。方法以2010年1月—2012年12月在郑州市妇幼保健院新生儿科接受肠外营养(PN)支持的240例新生儿为研究对象。根据是否发生胆汁淤积症,将其分为胆汁淤积症组和未发生胆汁淤积症组。对两组的临床资料进行单因素分析,根据单因素分析结果,再利用Logistic回归分析进行早产儿PNAC多因素分析。结果 240例早产儿中共发生PNAC 35例,占14.58%。单因素分析结果提示两组胎龄、出生体重、感染、喂养不耐受、PN持续时间、达到全胃肠内营养时间、氨基酸累积用量比较均有统计学意义。利用Logistic回归分析对上述指标进行多因素分析,结果提示胎龄、出生体重、PN持续时间、感染与PNAC发生有关,其中PN持续时间是PNAC发生的独立高危因素。结论胎龄越小,出生体重越轻,PN持续时间越长,发生PNAC的危险性越大,因此做好围生期的监测和保健,降低早产儿的出生率,尽早肠内喂养,缩短PN时间,是降低早产儿PNAC的重要措施。
Objective To investigate the risk factors of parenteral nutrition-associated cholestasis (PNAC) in preterm infants. Methods From January 2010 to December 2012 in Zhengzhou Maternal and Child Health Hospital, neonates receiving parenteral nutrition (PN) support of 240 newborns for the study. According to whether cholestasis occurs, it is divided into cholestasis group and cholestasis group. Univariate analysis of clinical data of two groups, according to the results of univariate analysis, and then use Logistic regression analysis of PNAC multivariate analysis of preterm children. Results Among 240 preterm infants, PNAC occurred in 35 cases (14.58%). Univariate analysis showed that gestational age, birth weight, infection, feeding intolerance, PN duration, total enteral nutrition time and amino acid accumulation in both groups were statistically significant. Logistic regression analysis of the above indicators by multivariate analysis showed that gestational age, birth weight, PN duration, infection and PNAC occurrence, of which PN duration is an independent risk factor for PNAC. CONCLUSIONS: The smaller the gestational age, the lower the birth weight, the longer the duration of PN, the greater the risk of PNAC. Therefore, monitoring and health care of the perinatal period should be done, the birth rate of premature children should be reduced, enteral feeding should be carried out as soon as possible and the PN time should be shortened , Is an important measure to reduce PNAC in preterm infants.