Albers Marcel J I J, de Gast-Bakker Dana-Anne H, van Dam Nicolette A M, Madern Gerard C, Tibboel Dick
Division of Intensive Care, Department of Pediatrics, Beatrix Children's Clinic, University Hospital Groningen, Room X4.111, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
Arch Surg. 2002 Jul;137(7):789-93. doi: 10.1001/archsurg.137.7.789.
Sepsis is an epiphenomenon of parenteral nutrition-associated cholestasis (PNAC) and not a causative factor, and the incidence of sepsis is not affected by the presence or absence of PNAC.
Observational cohort study.
Pediatric surgery department in a tertiary referral children's hospital.
Newborns receiving PN for at least 7 days following intestinal surgery.
The criteria for PNAC were as follows: PN for at least 14 consecutive days, conjugated bilirubin level greater than 1.5 mg/dL (>26 micromol/L), conjugated bilirubin fraction greater than 50%, and absence of another identifiable cause of cholestasis. The identification of septic events was based on Centers for Disease Control and Prevention criteria.
The patients (26 with PNAC and 72 without PNAC) were well comparable for underlying disease, gestational age, birth weight, and age at the start of PN. Time receiving PN and length of hospital stay were significantly (P<.001) longer in patients with PNAC. Parenteral nutrition-associated cholestasis was associated with male sex (P =.03; odds ratio, 2.8; 95% confidence interval, 1.1-7.1). The overall sepsis incidence was low (9 per 1000 hospital days). The sepsis incidence tended to be higher in patients with PNAC than in patients without PNAC (11.8 vs 7.1 per 1000 days; P =.08), but was significantly higher in male than in female patients (12.2 vs 5.6 per 1000 days; P =.01). Most septic events were caused by coagulase-negative staphylococci.
Sepsis is an epiphenomenon of PNAC rather than a causative factor. Moreover, male sex predisposes the newborn surgical patient to PNAC and to sepsis.
脓毒症是肠外营养相关胆汁淤积（PNAC）的一种附带现象而非致病因素，脓毒症的发生率不受PNAC存在与否的影响。
观察性队列研究。
一家三级转诊儿童医院的小儿外科。
肠道手术后接受肠外营养至少7天的新生儿。
PNAC的标准如下：连续肠外营养至少14天，结合胆红素水平大于1.5mg/dL（>26μmol/L），结合胆红素比例大于50%，且无其他可识别的胆汁淤积病因。脓毒症事件的判定基于疾病控制与预防中心的标准。
患者（26例有PNAC，72例无PNAC）在基础疾病、胎龄、出生体重及开始肠外营养时的年龄方面具有良好可比性。有PNAC的患者接受肠外营养的时间和住院时间显著更长（P<0.001）。肠外营养相关胆汁淤积与男性性别相关（P = 0.03；优势比，2.8；95%置信区间，1.1 - 7.1）。总体脓毒症发生率较低（每1000个住院日9例）。有PNAC的患者脓毒症发生率往往高于无PNAC的患者（每1000天11.8例对7.1例；P = 0.08），但男性患者的脓毒症发生率显著高于女性患者（每1000天12.2例对5.6例；P = 0.01）。大多数脓毒症事件由凝固酶阴性葡萄球菌引起。
脓毒症是PNAC的一种附带现象而非致病因素。此外，男性性别使新生儿外科患者易患PNAC和脓毒症。
