摘要
目的分析新生儿坏死性小肠结肠炎(NEC)术后静脉营养相关性胆汁淤积(PNAC)的临床特征,旨在为防治PNAC、改善预后提供参考。方法回顾性选取2016年6月至2021年6月于广西壮族自治区妇幼保健院、广西中医药大学第一附属医院接受剖腹探查术治疗的NEC患儿51例,根据术后是否发生PNAC分为PNAC组(18例)与非PNAC组(33例),比较分析两组的临床资料。结果两组患儿性别、宫内窘迫比例、小于胎龄儿比例、喂养不耐受比例、使用布洛芬比例、手术日龄、切除肠管长度、术后开奶时间比较差异均无统计学意义(P>0.05)。PNAC组胎龄、出生体重、术前给予肠内营养≥120 ml/(kg·d)比例低于非PNAC组,术前肠外营养超过14 d比例高于非PNAC组,术后肠外营养天数长于非PNAC组,差异有统计学意义(P<0.05)。两组患儿母亲的年龄以及剖宫产、绒毛膜羊膜炎、羊水污染、妊娠期高血压疾病发生率比较差异均无统计学意义(P>0.05)。结论早产、低出生体重、肠内营养建立困难、术前及术后肠外营养治疗周期长是NEC术后并发PNAC的高危因素,应早期积极筛查与干预,针对高危新生儿需更加优化营养管理。
Objective Analyzing the clinical data of parenteral nutrition associated cholestasis(PNAC)in necrotizing enterocolitis of newborn(NEC)aims to provide reference for the prevention and treatment of PNAC and improvement of prognosis.Method A retrospective study was conducted on 51 children with NEC who underwent exploratory laparotomy at the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region and the First Affi liated Hospital of Guangxi University of Traditional Chinese Medicine from June 2016 to June 2021.The patients were divided into PNAC group(18 cases)and non PNAC group(33 cases)based on whether PNAC occurred after surgery,and the clinical data of the two groups were compared and analyzed.Result There were no statistically signifi cant differences in gender,intrauterine distress ratio,proportion of infants smaller than gestational age,feeding intolerance ratio,use of ibuprofen ratio,surgical age,length of intestinal resection,and the time to start lactation after NEC surgery between the two groups of patients(P>0.05).The gestational age,birth weight,and proportion of preoperative enteral nutrition≥120 ml/(kg·d)in the PNAC group were lower than those in the non PNAC group.The proportion of preoperative parenteral nutrition exceeding 14 days was higher than that in the non PNAC group,and the number of postoperative parenteral nutrition days was longer than that in the non PNAC group,with statistical signifi cance(P<0.05).There was no statistically signifi cant difference in the age of the mothers of the two groups of children,as well as the incidence of cesarean section,chorioamnionitis,amniotic fluid contamination,and gestational hypertension(P>0.05).Conclusion Premature delivery,low birth weight,diffi culty in establishing enteral nutrition,and long period of preoperative and postoperative parenteral nutrition treatment are high-risk factors for PNAC after NEC surgery.Early screening and intervention should be actively carried out to optimize nutritional management for high-risk newborns.
作者
许靖
孔祥永
李伟伟
冯琳
奚碧冰
Xu Jing;Kong Xiangyong;Li Weiwei;Feng Lin;Xi Bibing(Department of Pediatrics,the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine,Nanning Guangxi 530023,China;The Seventh Medical Center of Chinese PLA General Hospital,Beijing 100700,China;Department of Neonatal,Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region,Nanning Guangxi 530003,China)
出处
《中国医刊》
2025年第7期823-826,共4页
Chinese Journal of Medicine
基金
国家自然科学基金(81860867)。
