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目的:探讨小剂量红霉素对极低出生体重儿(VLBW)胃肠外静脉营养相关性胆汁淤积症(PNAC)防治作用。方法:收集自2007年10月～2010年10月入住新生儿科重症监护病房极低出生体重儿,随机分为观察组和对照组,观察组入院即常规治疗基础上给予红霉素5 mg.kg-1.d-1静滴治疗,连用7～10 d。比较两组间PNAC发生率、PNAC危险因素的差异。结果:①观察组PN持续时间(19.3±2.3)d、住院时间(31.2±3.3)d,少于对照组〔(22.7±3.4)d,(35.2±3.7)d〕,两组比较有显著差异(P<0.05)。观察组发生喂养不耐受5例(14.3%),而对照组15例(42.9%),两组差异有统计学意义(P<0.05);②观察组发生胆汁淤积1例(2.86%),对照组发生胆汁淤积6例(17.10%),两组差异有统计学意义(P<0.05);③观察组患儿第21天血清结合胆红素、谷丙转氨酶水平较对照组低,但差异无统计学意义(P>0.05)。结论:小剂量红霉素降低喂养不耐受的发生,尽早建立完全胃肠道喂养,减少PN持续时间,减少PN用量,可降低极低出生体重儿PNAC的危险因素,降低PNAC发生率,因此对PNAC的发生有预防作用。同时,研究未观察到药物不良反应。
Objective: To investigate the preventive and therapeutic effects of low-dose erythromycin on nutrition-associated cholestasis (PNAC) in very low birth weight infants (VLBW). Methods: From October 2007 to October 2010 admitted to neonatal intensive care unit very low birth weight children were randomly divided into observation group and control group, the observation group was admitted to the conventional treatment on the basis of erythromycin 5 mg.kg -1.d-1 infusion therapy, once every 7 to 10 days. The incidence of PNAC and the risk factors of PNAC were compared between the two groups. Results: ① The PN duration (19.3 ± 2.3) d and hospitalization time (31.2 ± 3.3) days in observation group was significantly lower than that in control group [(22.7 ± 3.4) days and (35.2 ± 3.7) days〕 (P <0.05). Feeding intolerance in observation group occurred in 5 cases (14.3%), while in control group, 15 cases (42.9%), the difference was statistically significant (P <0.05); ② The observation group had cholestasis in 1 case (2.86% There were 6 cases (17.10%) of cholestasis in the control group, the difference between the two groups was statistically significant (P <0.05); ③ The serum bilirubin and alanine aminotransferase levels in the observation group were lower than those in the control group on the 21st day, No statistical significance (P> 0.05). Conclusion: Low dose erythromycin can reduce the incidence of feeding intolerance, establish complete gastrointestinal feeding as soon as possible, reduce the PN duration and reduce the dosage of PN, reduce the risk factors of PNAC in very low birth weight children and reduce the incidence of PNAC, therefore Prevent the occurrence of PNAC. At the same time, no adverse drug reactions were observed in the study.