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目的观察早产极低出生体重儿静脉营养相关胆汁淤积的发生率,并探讨胃肠外营养相关性胆汁淤积(PNAC)的相关高危因素。方法回顾分析本院2011~2013年108例进行静脉营养支持14d以上的早产极低出生体重儿,按是否发生PNAC分成PNAC组及非PNAC组,观察两组有伴窒息、败血症、肺透明膜病(HMD)、坏死性小肠结肠炎(NEC)、支气管肺发育不良(BPD)、动脉导管开放(PDA)等合并症的发生率。结果 PNAC组的胎龄、出生体重均小于非PNAC组,差异有统计学意义(P<0.05)。胃肠外营养持续时间、脂肪乳累计用量、氨基酸最大用量、肠道外营养(PN)热卡摄入量大于非PNAC组,差异有统计学意义(P<0.05)。开始喂养日龄、体重恢复迟于非PNAC组,且合并症发生机率增大。结论 PNAC发生与胎龄小、出生体重低、开奶时间迟、大剂量使用氨基酸和脂肪乳、PN热卡高、胃肠外营养时间长,有无并发症有关。
Objective To observe the incidence of nutritional cholestasis associated with preterm very low birth weight infants and to explore the risk factors associated with parenteral nutrition-associated cholestasis (PNAC). Methods Retrospective analysis of 108 cases from 2011 to 2013 in our hospital for intravenous nutritional support for preterm very low birth weight infants more than 14d, PNAC divided into PNAC group and non-PNAC group were observed, with two groups of asphyxia, sepsis, hyaline membrane disease (HMD), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), patent ductus arteriosus (PDA) and other complications. Results The gestational age and birth weight of PNAC group were significantly lower than those of non-PNAC group (P <0.05). The duration of parenteral nutrition, the cumulative amount of fat emulsion, the maximum amount of amino acids, and the intake of parenteral nutrition (PN) calorie were significantly higher than those of non-PNAC group (P <0.05). At the start of feeding, the body weight recovered later than non-PNAC group, and the incidence of comorbidities increased. Conclusions PNAC is associated with small gestational age, low birth weight, late opening of milk, high dose of amino acids and fat emulsion, high PN calorie, long parenteral nutrition, and complications.