早产儿胃肠外营养相关性胆汁淤积综合征的危险因素研究

Relationship between plasma motilin level and feeding intolerance in preterm infants

摘要:

目的：研究早产儿胃肠外营养相关性胆汁淤积综合征（PNAC）的危险因素。方法：回顾性分析2000年1月至2011年10月静脉营养应用超过14 d的244例早产儿的临床资料，通过病例对照研究调查PNAC发生的危险因素。结果：单因素分析发现，PNAC组（n=23）与非PNAC组（n=221）相比，胃肠外营养（PN）总应用时间更长、氨基酸累计用量及脂肪乳累计用量更大、氨基酸每日最高用量及脂肪乳每日最高用量更高、PN应用第14天时的静脉热卡更多、出生体重更小、贫血及新生儿感染发生率更多（P<0.05）。氨基酸累计用量超过PNAC组氨基酸累计用量的非PNAC组早产儿，脂肪乳累计用量大，PN总应用时间长，机械通气使用情况高， 胎龄更小。脂肪乳累计用量超过PNAC组脂肪乳累计用量的非PNAC组早产儿，胎龄更小。PN总应用时间超过PNAC组PN总应用时间的非PNAC组早产儿，胎龄更小。结论：PN总应用时间、氨基酸累计用量、氨基酸每日最高用量、脂肪乳累计用量、脂肪乳每日最高用量、PN应用14天时的静脉热卡、低体重、新生儿感染及贫血为PNAC的危险因素，其他危险因素需进一步探究。

Abstract:

OBJECTIVE: To observe changes in plasma motilin (MOT) level among preterm infants after birth, to investigate the relationship between plasma motilin level and feeding intolerance (FI), and to clarify the possible risk factors. METHODS: A total of 112 preterm infants were divided into feeding tolerance (FT) group (n=59) and FI group (n=53). Their plasma MOT levels were measured by radioimmunoassay on days 1, 4, 7 and 14 of life. The clinical data of FI group were collected and subjected to multivariate logistic regression analysis. RESULTS: Compared with the FT group, the FI group showed significantly lower plasma MOT levels on days 1, 4, 7 and 14 of life (P<0.05), and there was a positive correlation between plasma MOT level and gestational age, age in days, and volume of enteral feeding in the FI group. The lower the gestational age, the longer the FI duration. There was a negative correlation between the plasma MOT level on day 1 of life and the FI duration (r=-0.913, P<0.001). Gestational age and prenatal use of glucocorticoid were protective factors for FI, while fetal distress, placental abnormality and perinatal infection were risk factors for FI. CONCLUSIONS: Change in plasma MOT level may be closely related to the development of FI in preterm infants. Early monitoring of plasma MOT level may be useful for predicting the occurrence of FI.