膽汁鬱積是長期使用靜脈營養的嬰幼兒最主要的併發症，其發生率範圍非常廣，大約在21 ~ 58%左右。至今對於靜脈營養引起的膽汁鬱積還沒有一個有效的治療方式，雖然已有數種藥物被建議用在靜脈營養引起的膽汁鬱積，但確實效益仍未證明。
本文報告一個出生3天的早產兒，在使用靜脈營養的第37天，出現膽汁鬱積的症狀，如黃疸（皮膚與鞏膜顏色變黃）、糞便呈白色，實驗室檢查值serum bilirubin、serum alanine aminotransferase、serum aspartate aminotransferase、serum alkaline phosphatase、以及serum gamma-glutamyl transpeptidase都高出正常值；因此停用靜脈營養，並以ursodeoxycholic acid 30 mg/kg/day治療22天後，在serum bilirubin與serum gamma-glutamyl transpeptidase降回正常值，黃疸症狀改善，糞便顏色恢復正常的情形下出院。我們希望藉此案例，並以實證醫學的方式進行文獻回顧，為靜脈營養引起膽汁鬱積之嬰幼兒，提供適當的藥事照護給醫療人員參考。
Cholestasis is a major complication in infants who receive prolonged parenteral nutrition therapy. The incidence of parenteral nutrition associated cholestasis (PN - cholestasis) in infants varies widely between studies, ranging from 21% to 58%.
To date, no effective therapy exists for parenteral nutrition associated cholestasis. Several pharmacological agents have been proposed, but no conclusive benefits have been documented.
This case was a 3-day-old prematurity newborn, who received parenteral nutrition for appropriate weigh gain. Cholestasis appeared at 37 days after parenteral nutrition therapy. The patient was discontinued parenteral nutrition and received UDCA 30 mg/kg/day therapy for 22 days. Under stable condition, he was discharge and OPD follow-up was arranged.
We provide this case and use evidence-base medicine literatures review in order to conduct an appropriate pharmaceutical care of parenteral nutrition associated cholestasis for medical staffs.
