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目的为提高危重新生儿肠外营养支持的安全性和有效性提供依据。方法对1985.4-2005.3行5 d 以上静脉营养支持的612例住院新生儿资料进行分析。612例分为甲组(1985.4-1995.3)和乙组(1995.4-2005.3)。其中甲组70例再分为肠外营养相关胆汁淤积组(PNAC 组)6例和非 PNAC 组64例,乙组542例也分为 PNAC 组12例和非 PNAC 组530例。比较甲乙两组新生儿 PNAC 发生率及相关因素。结果接受5 d 以上静脉营养支持的新生儿 PNAC 总发生率为2.94%,甲组 PNAC 发生率为8.57%,乙组发生率为2.21%,后10年 PNAC 发病率有明显下降(OR 值为0.242,95% CI 为0.088～0.666)。PNAC 组的胎龄、出生体重均小于非 PNAC 组(其中胎龄33±5周比(36±4)周,P=0.009;OR 值为0.827,95% CI 为0.698～0.980。出生体重2003 g±743 g比2393 g±764 g,P=0.045;OR 值为1.001,95% CI 为0.999～1.002),而平均 PN 持续时间、热卡摄入量均大于非 PNAC 组(其中 PN 持续时间32 d±30 d 比13 d±10 d,P=0.000;OR 值为1.072,95%CI 为1.032～1.112。PN 摄入量(272±46)kJ/(kg·d)[(65.0±10.9 kcal/(kg·d),(1 kcal=4.184 kJ)]比(232±55)kJ/(kg·d)[(55.5±13.1)kcal/(kg·d)],P=0.002;OR 值为1.066,95% CI 为1.012～1.122)。非 PNAC 组体重增加与 PNAC 组相比有增加趋势[(20±27)g/d 比(9±19)g/d,P=0.175]。结论 PNAC 发生与早产、低出生体重、PN 持续时间超过2周、PN 提供的热卡量过高有关。
Objective To provide evidence for improving the safety and efficacy of parenteral nutritional support in critically ill neonates. Methods The data of 612 inpatients with intravenous nutrition support over 5 days from 1985 to 2005 were analyzed. 612 cases were divided into Group A (1985.4-1995.3) and Group B (1995.4-2005.3). Among them, 70 cases in group A were further divided into 6 cases in PNAC group and 64 cases in non-PNAC group, and 542 cases in group B were also divided into PNAC group (12 cases) and non-PNAC group (530 cases). Compare the incidence of neonatal PNAC between A and B groups and related factors. Results The overall incidence of PNAC was 2.94% in newborns receiving intravenous nutrition support for more than 5 days. The incidence of PNAC in group A was 8.57% and the incidence of PNAC was 2.21%. The incidence of PNAC was significantly decreased after 10 years (OR = 0.242 , 95% CI 0.088 ~ 0.666). The gestational age and birth weight of PNAC group were less than that of non-PNAC group (P = 0.009, P = 0.009, P = 0.0027, P = 0.0027, 95% CI 0.636-0.980, ± 743 g vs 2393 g ± 764 g, P = 0.045; odds ratio was 1.001; 95% CI 0.999 to 1.002), while mean PN duration and calorie intake were greater than those of non-PNAC group (PN duration 32 d ± 30 d vs 13 d ± 10 d, P = 0.000; odds ratio was 1.072; 95% CI was 1.032-1 1.112; PN intake was 272 ± 46 kJ / kg · d [(65.0 ± 10.9 kcal / (kg · d), (1 kcal = 4.184 kJ)] (232 ± 55) kJ / (kg · d) [(55.5 ± 13.1) kcal / (kg · d)], P = 0.002; 1.066, and 95% CI 1.012-1.122) .Compared with PNAC group, body weight gain increased in non-PNAC group ([20 ± 27] g / d vs 9 ± 19 g / d, P = 0.175] Occurs with premature birth, low birth weight, PN duration of more than 2 weeks, the PN provided by the heat card is too high.