早产儿肝胆并发症高危因素及早期干预的临床

2012年10月第9卷第29期

·临床研究·

CHINA MEDICAL HERALD 中国医药导报随着现代医学的进步，早产儿的存活率显著得到提高，在早产儿治疗中胃肠道外营养（parenteral nutrition ，PN ）是一个重要的突破，极大地降低了早产儿、低出生体重儿等危重新生儿的病死率[1]。而由于早产儿特殊的病理及生理特征，PN 早产儿所发生的肝胆并发症问题尚无确切有效的治疗方法[2]。本研究通过分析早产儿肝胆并发症的发病率、高危因素，为临床寻找早产儿肝胆并发症有效的早期干预措施提供临床资料，以减少早产儿相关肝胆并发症的发生，提高早产儿抢救成功后的生活质量。1资料与方法1.1一般资料

2012年1~4月我院儿科新生儿病区收治的采用PN 的

早产儿30例，胎龄32~36周，平均（33.2±1.72）周；出生体重1500~2480g ；均为出生后2d 内入院，3d 内开始PN 。排除先天畸形、遗传代谢性疾病、需进行外科手术治疗的患儿。1.2喂养方法

所有患儿24h 内经口试喂养，均完全不能耐受胃肠道喂养或经口喂养不足，入院后建立外周静脉通道，并给予葡萄糖输入，均于出生后2~3d 开始使用氨基酸及脂肪乳，起始用量均为0.5g/（kg ·d ），按0.5g/（kg ·d ）酌情加量，最大用量均为3g/（kg ·d ），同期补充微量元素、维生素、电解质及葡萄糖。当患儿能吸吮，通过胃肠道摄入能量超过生理需要量的2/3，即停止PN ，过渡至完全胃肠道内营养。1.3观察指标

观察记录患儿肠外营养开始日龄，持续时间，葡萄糖、氨

早产儿肝胆并发症高危因素及早期干预的临床研究

黄金科叶建武单海州张伟强朱月胜李长根

广东省增城市新塘镇中心卫生院仙村分院，广东增城511335

[摘要]目的分析早产儿胃肠道外营养（PN ）相关肝胆并发症的发病率、高危因素及早期干预。方法对30例PN 早产儿的肠外营养开始日龄、持续时间及葡萄糖、氨基酸和脂肪乳应用情况，PN 热卡摄入量，达到全肠道营养时间，有无出现胃肠道外营养相关胆汁淤积（PNAC ）并发症进行观察及记录，并进行谷丙转氨酶、总胆红素、结合胆红素、碱性磷酸酶生化指标检测。结果5例PN 早产儿出现PNAC ，占16.7%；PNAC 患儿与无PNAC 患儿在脂肪乳、氨基酸、葡萄糖累积用量及PN 开始日龄、PN 时间、PN 热卡摄入量、达到全肠道营养时间方面比较，差异有统计学意义（P <0.05）；PN 后2周谷丙转氨酶、总胆红素、结合胆红素、碱性磷酸酶，PNAC 组明显高于无PNAC 组，差异有统计学意义（P <0.05）。结论PN 持续时间过长可大大增加胆汁淤积损伤肝脏的几率，尽早地开始肠内营养，是避免出现与PN 相关肝胆并发症的有效措施，密切监测患儿的肝肾功能、胆红素指标，可帮助减少早产儿肝胆并发症的发生。[关键词]早产儿；胃肠道外营养；肝胆并发症[中图分类号]R459.3[文献标识码]A [文章编号]1673-7210（2012）10（b ）-0053-02

Clinical study of the risk factors and early intervention of the preterm in -fants'hepatobiliary complications

HUANG Jinke YE Jianwu SHAN Haizhou ZAHNG Weiqiang ZHU Yuesheng LI Changgen

Xiancun Branch Hospital of Center Hospital of Xintang Town,Zengcheng City,Guangdong Province,Zengcheng 511335,China

[Abstract]Objective To analyze the incidence of the disease,the risk factors and early intervention of relavent hepatobil -iary complications from the parenteral nutrition (PN)children.Methods The beginning day of the parenteral nutrition,the resisting time,the uesage of glucose,amino acids and fat emulsion,the PN caloric intake,the time of enteral nutrition,with or without parenteral nutrition-associated cholestasis (PNAC)complications were observed and detected from 30cases of PN preterm infants.Then biochemical markers of alanine aminotransferase,total bilirubin,direct bilirubin and alkaline phosphatase were detected.Results 5cases of PN preterm infants had PNAC,was 16.7%;there was statistically significant (P <0.05)in aspect of the cumulative dosage of the fat emulsion,amino acids and glucose,the PN beginning day,PN time,PN caloric intake,and the enteral nutrition time between PNAC children and non-PNAC children.After 2weeks of PN,the alanine aminotransferase,total bilirubin,direct bilirubin,and alkaline phosphatase of the PNAC group were significant -ly higher than the non PNAC group,there were significant differences (P <0.05).Conclusion PN duration too long can greatly increase the probability of liver damage by cholestasis.So starting enteral nutrition as early as possible is effective to avoid the emergence of PN-related hepatobiliary complications.Closely monitoring the children's liver and kidney func -tion and the bilirubin index can help reduce the incidence of hepatobiliary complications of premature children.[Key words]Preterm infants;Parenteral nutrition;Hepatobiliary complications

[基金项目]广东省广州市医药卫生科技项目（项目编号：20121A041020）。53