中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2011年
3期
199-202
,共4页
王陈红%施丽萍%吴秀静%陈正%罗芳
王陳紅%施麗萍%吳秀靜%陳正%囉芳
왕진홍%시려평%오수정%진정%라방
早产儿%低出生体重儿%胃肠外营养%胆汁淤积症
早產兒%低齣生體重兒%胃腸外營養%膽汁淤積癥
조산인%저출생체중인%위장외영양%담즙어적증
Preterm infant%Low birth weight infant%Parenteral nutrition%Cholestasis
目的 分析早产儿胃肠外营养相关性胆汁淤积症(PNAC)的临床特点及影响因素,探讨预后.方法 对2007年7月至2009年6月,我院新生儿监护室的159例接受＞14 d胃肠外营养(PN)的体重＜2000 g和(或)胎龄＜34周的早产儿进行分析,以其中发生PNAC的40例作为PNAC组,另将剩余的119例非胆汁淤积患儿作为对照组.观察PNAC组患儿的胆汁淤积发生时间、持续时间、胆汁淤积程度及肝功能损害情况.分析PANC的相关因素.结果 PNAC平均发生在胃肠外营养后(3.3±1.6)周,一般持续(13.3±5.4)周,其直接胆红素峰值为(135.2±65.5)μmol/L;PNAC患儿中73.7%伴有肝功能损害,肝损一般发生于胃肠外营养后(6.6±3.0)周,常持续(9.5±5.4)周,谷丙转氨酶峰值(121.5±48.4)U/L,谷草转氨酶峰值(239.8±122.3)U/L.对可能的PNAC相关因素进行Logistic回归分析提示开始喂养时间、PN持续时间、窒息、SGA、颅内出血与PNAC的发生相关.结论 PNAC的预后良好.在条件允许下,尽早的肠内喂养、缩短PN时间、避免一些并发症如窒息、败血症、颅内出血等可以减少PNAC的发生.
目的 分析早產兒胃腸外營養相關性膽汁淤積癥(PNAC)的臨床特點及影響因素,探討預後.方法 對2007年7月至2009年6月,我院新生兒鑑護室的159例接受＞14 d胃腸外營養(PN)的體重＜2000 g和(或)胎齡＜34週的早產兒進行分析,以其中髮生PNAC的40例作為PNAC組,另將剩餘的119例非膽汁淤積患兒作為對照組.觀察PNAC組患兒的膽汁淤積髮生時間、持續時間、膽汁淤積程度及肝功能損害情況.分析PANC的相關因素.結果 PNAC平均髮生在胃腸外營養後(3.3±1.6)週,一般持續(13.3±5.4)週,其直接膽紅素峰值為(135.2±65.5)μmol/L;PNAC患兒中73.7%伴有肝功能損害,肝損一般髮生于胃腸外營養後(6.6±3.0)週,常持續(9.5±5.4)週,穀丙轉氨酶峰值(121.5±48.4)U/L,穀草轉氨酶峰值(239.8±122.3)U/L.對可能的PNAC相關因素進行Logistic迴歸分析提示開始餵養時間、PN持續時間、窒息、SGA、顱內齣血與PNAC的髮生相關.結論 PNAC的預後良好.在條件允許下,儘早的腸內餵養、縮短PN時間、避免一些併髮癥如窒息、敗血癥、顱內齣血等可以減少PNAC的髮生.
목적 분석조산인위장외영양상관성담즙어적증(PNAC)적림상특점급영향인소,탐토예후.방법 대2007년7월지2009년6월,아원신생인감호실적159례접수＞14 d위장외영양(PN)적체중＜2000 g화(혹)태령＜34주적조산인진행분석,이기중발생PNAC적40례작위PNAC조,령장잉여적119례비담즙어적환인작위대조조.관찰PNAC조환인적담즙어적발생시간、지속시간、담즙어적정도급간공능손해정황.분석PANC적상관인소.결과 PNAC평균발생재위장외영양후(3.3±1.6)주,일반지속(13.3±5.4)주,기직접담홍소봉치위(135.2±65.5)μmol/L;PNAC환인중73.7%반유간공능손해,간손일반발생우위장외영양후(6.6±3.0)주,상지속(9.5±5.4)주,곡병전안매봉치(121.5±48.4)U/L,곡초전안매봉치(239.8±122.3)U/L.대가능적PNAC상관인소진행Logistic회귀분석제시개시위양시간、PN지속시간、질식、SGA、로내출혈여PNAC적발생상관.결론 PNAC적예후량호.재조건윤허하,진조적장내위양、축단PN시간、피면일사병발증여질식、패혈증、로내출혈등가이감소PNAC적발생.
Objective To analyze the clinical features and influential factors of parenteral nutrition associated cholestasis (PNAC) in preterm infants. Method A total of 159 infants with birth weight less than 2000 grams and/or gestational age less than 34 weeks were exposed to parenteral nutrition for longer than 14 days in NICU during the period from July 2007 to June 2009. Of these infants, 40 cases who had PNAC were aligned into the PNAC group, and the other 119 cases without PNAC were aligned into the nonPNAC group. PNAC occurring time, duration, the degree of PNAC and hepatic injury were observed.Logistic regression analysis was performed to evaluate the correlative factors of PNAC. Result PNAC occurred about (3.3 ± 1.6) weeks after beginning PN, usually lasted for (13.3 ± 5.4) weeks. The maximum direct bilirubin was ( 135.2 ± 65. 5 ) μmol/L. Of the PNAC patients, 73.7% suffered from hepatic injury. Hepatic injury usually occurred ( 6. 6 ± 3.0 ) weeks after beginning PN, and lasted for (9. 5 ±5.4) weeks. The highest alanine aminotransferase (ALT) was ( 121.5 ±48.4) U/L. The logistic regression of the possible correlative factors showed that time to start enteric feeding, persistence time of PN,asphyxia, small for gestational age, intracranial hemorrhage, were related to PNAC. Conclusion The prognosis of PNAC was good. Early enteral feeding, shorter time of PN, avoidance of the complications such as asphyxia and sepsis, were the important measures to lower PNAC.
