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目的:探讨早产儿胃肠外营养相关性胆汁淤积(PNAC)的危险因素和有效的防治措施。方法:将299例行PN治疗的早产儿根据是否为PNAC分为PNAC组(n=32例)和非PNAC组(n=267例)。比较两组早产儿的临床和营养因素,采用Logistic回归分析危险因素。结果:两组早产儿在胎龄、出生时体重、贫血、新生儿感染等方面存在显著性差异(P<0.05);两组早产儿在禁食时间,氨基酸、脂肪乳和乳类的热量比,每天总热量和喂养困难等方面亦存在显著性差异(P<0.05)。多因素分析结果显示,禁食时间长、氨基酸和脂肪乳提供热量比率高、胎龄低、新生儿感染均为发生PNAC的危险因素(P<0.05)。乳类提供热量比率高则是保护性因素(P<0.05)。结论:禁食时间长、氨基酸与脂肪乳提供热量比率高、胎龄低、新生儿感染等为PNAC的危险因素。依此制订有效的防治措施,可明显降低PNAC的发生率。
Objective: To explore the risk factors of parenteral nutrition-associated cholestasis (PNAC) in preterm infants and the effective prevention and treatment measures. METHODS: Two hundred and ninety-nine preterm infants treated with PN were divided into PNAC group (n = 32) and non-PNAC group (n = 267) according to whether they were PNAC or not. The clinical and nutritional factors of the two groups were compared, and the risk factors were analyzed by Logistic regression. Results: There were significant differences in gestational age, birth weight, anemia and neonatal infection in preterm infants of both groups (P <0.05). The heat ratio of amino acids, fat emulsion and milk in preterm infants , Total daily calorie and feeding difficulties, there are also significant differences (P <0.05). Multivariate analysis showed that fasting fasting, amino acid and fat emulsion to provide high calorie ratio, low gestational age, neonatal infection were risk factors PNAC (P <0.05). The higher caloric value of milk provided the protective factor (P <0.05). Conclusion: Fasting for a long time, amino acids and fat milk to provide high calorie ratio, low gestational age, neonatal infection is the risk factor for PNAC. The development of effective prevention and control measures can significantly reduce the incidence of PNAC.