Qiao Qi,Zhang Zhibo.Analysis of risk factors of cholestatic liver injury in children with complex intestinal atresia and nutrition management[J].Journal of Clinical Pediatric Surgery,2024,(01):35-39.[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
- Title:
- Analysis of risk factors of cholestatic liver injury in children with complex intestinal atresia and nutrition management
- Keywords:
- Complex Intestinal Atresia; Perioperative Period; Management; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨复杂性肠闭锁患儿围手术期营养管理及术后发生胆汁淤积性肝损伤的相关因素。 方法 回顾性分析中国医科大学附属盛京医院2018年1月至2022年12月收治的复杂性肠闭锁患儿临床资料,收集患儿年龄、性别、手术日龄、是否早产、出生体重、临床表现、治疗过程、出院诊断、病理结果、预后等信息,以结合胆红素34.2 μmol/L(2 mg/dl)作为诊断胆汁淤积的标准,将患儿分为胆汁淤积组和非胆汁淤积组,分析导致复杂性肠闭锁患儿术后发生胆汁淤积性肝损伤的相关因素。 结果 本研究共纳入45例复杂性肠闭锁患儿,31例为产前检查发现存在肠管异常,14例为生后出现症状就诊;32例合并胎粪性腹膜炎、肠坏死、肠穿孔等;ⅢB型肠闭锁12例,Ⅳ型肠闭锁10例,ⅢB型合并Ⅳ型肠闭锁5例;34例闭锁部位位于回肠(34/45,75.56%),10例位于空肠(10/45,22.22%),1例位于十二指肠(1/45,2.22%)。开奶时间为(11±4.57)d,全胃肠外营养(total parenteral nutrition, TPN)使用时间为(12.82±5.41)d。14例发生胆汁淤积性肝损伤。单因素分析发现,早产、产前发现肠管异常、闭锁部位位于十二指肠及空肠、使用TPN时间长的患儿更容易发生胆汁淤积(P＜0.05)。多因素Logistic回归分析发现,产前发现肠管异常(OR=1.021,95%CI:1.001~1.042)、早产(OR=1.005,95%CI:1.000~1.011)、闭锁部位位于空肠及十二指肠(OR=4.423,95%CI:3.876~5.212)、TPN使用时间长(OR=6.798,95%CI:6.191~7.794)是结合胆红素升高的独立相关因素,其中长时间使用TPN是导致胆汁淤积性肝损伤的最大风险因素。 结论 长时间慢性不全肠梗阻、使用TPN时间长等因素是发生胆汁淤积性肝损伤的危险因素;改良术式、缩短肠外营养时间是防止胆汁淤积性肝损伤的关键。
- 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,operative age,gestation age,birth weight,clinical manifestations,treatment protocols,diagnoses,pathological results and outcomes were examined.Conjugated bilirubin 34.2 μmol/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 symptomatic immediately after birth and 32 cases developed the complications of meconium peritonitis,intestinal necrosis and intestinal perforation.The clinical types were ⅢB (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 preterm 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 factors 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 approaches and shortening the duration of parenteral nutrition are vital for preventing cholestatic liver injury.
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备注/Memo
收稿日期:2023-5-24。
基金项目:国家自然科学基金(82170529); 辽宁科技厅项目(2021YFC2701003)
通讯作者:张志波,Email:zhangzb@sj-hospital.org