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目的研究早产儿胃肠外营养相关性胆汁淤积的影响因素。方法回顾性分析2009年10月至2014年10月在东南大学附属中大医院新生儿监护病房住院早产儿静脉营养应用超过14 d的234例早产儿的临床资料,通过病例对照研究调查胆汁淤积发生的影响因素。结果共入组234例早产儿。其中男148例,女86例。胆汁淤积组39例,非胆汁淤积组195例。胆汁淤积组与非胆汁淤积组相比,胃肠外营养(PN)的总天数、禁食时间、累积热卡、脂肪乳累积用量、新生儿窒息、颅内出血、住院时间及分娩方式有统计学差异(P<0.05,P<0.01);两组患儿在出生体重、胎龄、小儿复方氨基酸累积用量、日增长体重、是否双胎、性别、SGA、试管婴儿、电解质紊乱、新生儿肺炎及NEC等方面比较无统计学差异(P均>0.05)。Logistic危险因素分析显示胆汁淤积组与非胆汁淤积组患儿在肠外营养(PN)持续时间、新生儿窒息、颅内出血、脂肪累积用量、禁食时间、累积热卡等方面差异均有统计学意义(P均<0.05),为发生胆汁淤积的危险因素。结论对于胃肠外营养的早产儿减少禁食时间、缩短PN持续时间,减少脂肪乳用量、减少累积用量以及积极治疗疾病(新生儿窒息和颅内出血)能减少胆汁淤积发生。
Objective To study the influencing factors of parenteral nutrition-related cholestasis in premature infants. Methods A retrospective analysis of clinical data of 234 preterm infants with IVF over 14 days admitted to neonatal intensive care unit of CUHK affiliated southeast university from October 2009 to October 2014 was conducted to investigate the occurrence of cholestasis by case control study The impact of factors. Results A total of 234 preterm infants were included. There were 148 males and 86 females. 39 cases of cholestasis group, 195 cases of non-cholestasis group. Cholestasis group Compared with non-cholestasis group, the total number of parenteral nutrition (PN) days, fasting time, cumulative calorie, accumulation of fat emulsion, neonatal asphyxia, intracranial hemorrhage, length of stay and mode of delivery were statistically (P <0.05, P <0.01). The differences of birth weight, gestational age, accumulated amino acid accumulation in children, daily weight gain, twins, sex, SGA, IVF, electrolyte imbalance, neonatal pneumonia, NEC and other aspects no statistical difference (P all> 0.05). Logistic risk factors analysis showed that there were significant differences in the duration of parenteral nutrition (PN), neonatal asphyxia, intracranial hemorrhage, accumulation of fat, fasting time, cumulative caloric value between cholestasis group and non-cholestatic group Significance (P <0.05), as a risk factor for the occurrence of cholestasis. Conclusions Reducing fasting duration, shortening PN duration, decreasing fat emulsion dosage, decreasing cumulative dosage, and actively treating diseases (neonatal asphyxia and intracranial hemorrhage) in preterm infants with parenteral nutrition can reduce cholestasis.