临床小儿外科杂志2024，Vol.23Issue(1)：35-39,5.DOI:10.3760/cma.j.cn101785-202305041-007
复杂性肠闭锁营养管理及胆汁淤积性肝损伤的相关因素分析
Analysis of risk factors of cholestatic liver injury in children with complex intestinal atresia and nutri-tion management
摘要
Abstract
Objective To explore the factors associated with cholestatic liver injury in children with complex intestinal atresia(CIA)and nutrition management..Methods From January 2018 to December 2022,the relevant clinical data were retrospectively reviewed for 45 hospitalized CIA children.Age,gender,op-erative age,gestation age,birth weight,clinical manifestations,treatment protocols,diagnoses,pathological re-sults and outcomes were examined.Conjugated bilirubin 34.2μmol/L(2 mg/dl)was employed as a diagnostic criterion for cholestasis.They were assigned into two groups of cholestatic(n=14)and non-cholestatic(n=31).Results Total parenteral nutrition of low energy was given before and 2 days after surgery,and recovery stage nutrition was given 2 days later.Enteral nutrition started upon a relief of intestinal obstruction symptoms.Among them,31 cases were detected by routine prenatal ultrasonic examination.Fourteen cases were symptomat-ic immediately after birth and 32 cases developed the complications of meconium peritonitis,intestinal necrosis and intestinal perforation.The clinical types were Ⅲ B(n=12)and Ⅳ(n=10)And the former was mixed with type Ⅳ(n=5).34 cases were located in ileum(34/45,75.56％),10 in jejunum(10/45,22.22％),and 1 in duodenum(1/45,2.22％).Mean time of oral feeding was(11±4.57)day and mean duration of TPN(12.82±5.41)day.And 14 children developed cholestatic liver injury.Univariate analysis indicated that pre-term delivery,prenatal intestinal abnormalities,duodenojejunal atresia and long-term TPN were risk factors(P＜0.05).Multivariate Logistic regression analysis revealed that prenatal intestinal abnormalities(OR=1.021,95％CI:1.001-1.042),preterm delivery(OR=1.005,95％CI:1.000-1.011),closure site(OR=4.423,95％CI:3.876-5.212)and TPN duration(OR=6.798,95％CI:6.191-7.794)were independent risk fac-tors associated with elevated bilirubin.And long-term TPN was the greatest risk factor.Conclusions The risk factors of cholestatic liver injury are chronic incomplete obstruction and long-term TPN.Optimizing operative ap-proaches and shortening the duration of parenteral nutrition are vital for preventing cholestatic liver injury.关键词
复杂性肠闭锁/围术期/管理/外科手术/儿童Key words
Complex Intestinal Atresia/Perioperative Period/Management/Surgical Procedures,Op-erative/Child引用本文复制引用
乔奇,张志波..复杂性肠闭锁营养管理及胆汁淤积性肝损伤的相关因素分析[J].临床小儿外科杂志,2024,23(1):35-39,5.基金项目
国家自然科学基金(82170529) （82170529）
辽宁科技厅项目(2021YFC2701003)National Natural Science Foundation of China(81270437) （2021YFC2701003）
Liaoning Provincial Depart-ment of Science & Technology Project(2021YFC2701003) （2021YFC2701003）
