极低出生体质量儿胃肠外营养相关性胆汁淤积危险因素临
床分析
杨军;李水霞;陈莉娜
【期刊名称】《中华妇幼临床医学杂志（电子版）》 【年(卷),期】2015(000)005
【摘要】Objective To investigate the risk factors of parenteral nutrition-associated cholestasis (PNAC)in very low birth weight infants (VLBWI).Methods VLBWI who were accorded with inclusion and exclusion criteria of this study:treatment for parenteral nutrition (PN)for over 14 days in West China Second University Hospital of Sichuan University from May 2008 to May 2014 were chosen as study subjects.By retrospectively analyzed method,they were divided into PNAC group and non PNAC group according to whether suflered from PNAC or not.First of all,according to the clinical experience,the influence factors of PNAC were identified and carried on the single factor analysis,then comprehensively considered with statistically significant variables
and
professional
knowledge,multiple
factors
unconditional logistic regression analysis method was used to further analyze the independent and risk factors of PNAC. Results ① A total of 1 72 cases of VLBWI were chosen as study subjects finally.According to whether suffered from PNAC or not,they were divided into PNAC group (n=29)and non PNAC group (n=143), and the
incidence of PNAC was 1 6.9%.There were no significant differences between two groups among gender ratio,gestational age at delivery and mode of delivery,etc.(P > 0.05 ).② According to clinical experience,the single factor analysis results about 27 clinical observation items and 1 9 nutritional factors which may lead to PNAC showed that 8 clinical observation items and 5 nutritional factors were influence factors of PNAC,such as VLBWI,less than appropriate for gestational age (SGA),long fasting time and longer duration of PN,higher amino acid and fat emulsion calories,milk lower calories,higher
neonatal
infections,such
as
infectious
pneumonia,sepsis,neonatal necrotizing enterocolitis (NEC)and septic shock rate,lower breastfeeding and oral probiotics rate,and all the differences
were
statistically
93,2.81
significant 5,2.5
1
(t/χ2 9,4.61
=3.306,3.306,1.790,1.231,3.1
5,3.949,3.920,3.861,5.656,5.535;P <0.05).The unconditioned and multi-factor of logistic regression analysis results of influence factors may cause PNAC showed that neonatal infections,SGA,VLBWI,long fasting time,long duration of PN, higher amino acid and fat emulsion calories were the risk factors of PNAC (OR = 8.785,8.785,8.785, 3.85 1,6.746,7.1 13,3.765;95%CI
:3.603-25.236,1.526-8.932,2.534-1
9.65
1,1.473-1
5.326,1.21 9-12.471,3.124-1 9.358,3.230-26.246;P <0.05),milk high calorie,breastfeeding and oral probiotics were protective factors of
PNAC (OR = 0.01 6,0.01 6,0.01 6;95%CI :0.027-0.679,0.076-0.531,0.013-0.1
69;P
<0.05).Conclusions
Neonatal
infections,SGA,low
birth
weight,long duration of PN,higher amino acid and fat emulsion calorie,long fasting time are significant risk factors of PNAC in our study. Protective factors are high milk calorie,breastfeeding and oral probiotics.%目的：探讨极低出生体质量儿(VLBWI)胃肠外营养相关性胆汁淤积(PNAC)发病的独立危险因素。方法选择2008年5月至2014年5月在四川大学华西第二医院接受胃肠外营养(PN)持续时间≥14 d,符合本研究纳入与排除标准的 VLBWI 的临床病历资料为研究对象。采用回顾性分析方法,将其按照接受持维 PN 后是否发生 PNAC,分为 PNAC 组和非 PNAC 组。首先根据临床经验,确定导致PNAC 的影响因素,并对其进行单因素分析；再根据单因素分析结果及专业知识,进一步进行非条件多因素logistic 回归分析,最终确定导致 PNAC 的独立危险因素。结果①最终符合本研究纳入与排除标准的VLBWI 共计172例,其中非 PNAC 组为143例,PNAC 组为29例,PNAC 发生率为16.9%。两组受试者性别构成比、胎龄及分娩方式等比较,差异均无统计学意义(P >0.05)。②根据临床经验,对可能导致PNAC 的临床观察项目(27项)与营养因素项目(19项)相关影响因素的单因素分析结果显示：8项临床观察项目与5项营养因素项目为可能导致 PNAC 的影响因素,如出生体质量轻,小于胎龄(SGA)儿,PN 持续时间及禁食时间长,氨基酸热卡及脂肪乳热卡高,奶热卡低,感染性肺炎、败血症、新生儿坏死性小肠结肠炎(NEC)及感染性休克率高,母乳喂养及口服益生菌均为可能导致 PNAC 发生的影响因素,差异均有统计学意义(t/χ2=-3.306,4.424,1.790,1.231,3.193,2.815,2.519,4.615,3.949,3.920,3.861,5.656,5
极低出生体质量儿胃肠外营养相关性胆汁淤积危险因素临床分析
