Department of Surgery and the Vascular Biology Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
JPEN J Parenter Enteral Nutr. 2013 Jul;37(4):498-505. doi: 10.1177/0148607112453072. Epub 2012 Jul 5.
One of the most common and severe complications of long-term parenteral nutrition (PN) is PN-associated cholestasis. The soybean oil-based lipid emulsion administered with PN has been associated with cholestasis, leading to an interest in lipid reduction strategies. The purpose of this study was to determine whether the provision of a soybean oil-based lipid emulsion at 1 g/kg/d compared with 2-3 g/kg/d is associated with a reduced incidence of cholestasis.
Retrospective review of neonates admitted between 2007 and 2011 with a gastrointestinal condition necessitating ≥ 21 days of PN support. Neonates were divided into 2 groups based on the intravenous lipid emulsion dose: 1-g group (1 g/kg/d) and 2- to 3-g group (2-3 g/kg/d). The primary outcome measure was the incidence of cholestasis.
Sixty-one patients met inclusion criteria (n = 29, 1-g group; n = 32, 2- to 3-g group). The 2 groups did not differ in any baseline characteristics other than associated comorbidities that were more common in the 2- to 3-g group. The duration of PN, the number of operative procedures and bloodstream infections, and enteral nutrition (EN) were similar between groups. The incidence of cholestasis was not different between groups (51.7%, 1-g group; 43.8%, 2- to 3-g group; P = .61), and there was no difference between groups in the time to cholestasis (32.6 ± 24.1 days, 1-g group; 27.7 ± 10.6 days, 2- to 3-g group; P = .48). Overall, 44.8% of patients with cholestasis were transitioned to full EN, and 55.2% were transitioned to a fish oil-based lipid emulsion after which the direct bilirubin normalized in all patients.
Lipid reduction to 1 g/kg/d does not prevent or delay the onset of cholestasis in neonates.
长期肠外营养（PN）最常见和最严重的并发症之一是 PN 相关胆汁淤积。与 PN 一起给予的大豆油基脂肪乳剂与胆汁淤积有关，这导致人们对降低脂肪策略产生了兴趣。本研究的目的是确定与 2-3 g/kg/d 相比，每天给予 1 g/kg/d 的大豆油基脂肪乳剂是否与降低胆汁淤积的发生率有关。
回顾性分析 2007 年至 2011 年间因胃肠道疾病需要接受≥21 天 PN 支持的新生儿。根据静脉内脂肪乳剂剂量将新生儿分为 2 组：1 g 组（1 g/kg/d）和 2-3 g 组（2-3 g/kg/d）。主要结局测量指标是胆汁淤积的发生率。
61 名患者符合纳入标准（n=29，1 g 组；n=32，2-3 g 组）。除了 2-3 g 组更常见的相关合并症外，两组在其他任何基线特征上均无差异。PN 持续时间、手术次数和血流感染以及肠内营养（EN）在两组之间相似。两组的胆汁淤积发生率无差异（51.7%，1 g 组；43.8%，2-3 g 组；P=.61），两组胆汁淤积发生的时间也无差异（32.6±24.1 天，1 g 组；27.7±10.6 天，2-3 g 组；P=.48）。总体而言，44.8%的胆汁淤积患者过渡到完全 EN，55.2%的患者过渡到鱼油基脂肪乳剂后，所有患者的直接胆红素恢复正常。
将脂肪摄入量减少到 1 g/kg/d 并不能预防或延迟新生儿胆汁淤积的发生。
