摘要
目的:分析新生儿坏死性小肠结肠炎(NEC)的临床高危因素与预后,为早期诊断及预防提供依据。方法:回顾性分析2015年1月1日至2018年12月31日昆明市儿童医院新生儿科收治的291例NEC住院新生儿的临床资料,按Bell-NEC分期将本组病例分为Ⅰ期组、Ⅱ/Ⅲ期组;对两组病例进行包括围生期相关因素、首发症状、临床表现、并发症、治疗时间、手术结果及预后等方面的临床资料、感染指标、辅助检查及预后对比分析。结果:NEC的发生率为同期住院患儿的1.86%(291/15645),其中Ⅰ期组180例、Ⅱ/Ⅲ期组111例;早产儿Ⅰ期组34例(18.9%)、Ⅱ/Ⅲ期组54例(48.6%);低出生体质量儿Ⅰ期组30例(16.7%),Ⅱ/Ⅲ期组53例(47.7%);非母乳喂养儿Ⅰ期组73例(40.6%)Ⅱ/Ⅲ期组70例(63.1%);早产儿、低出生体质量儿、非母乳喂养儿导致的NEC在Ⅱ/Ⅲ期发生率较高(χ^(2)=28.825、32.534、12.212,均P<0.05);新生儿合并动脉导管未闭39例(13.40%)、凝血功能障碍29例(9.97%)、血糖异常16例(5.4%)、病理性黄疸47例(16.15%)或母亲妊娠期糖尿病12例(4.12%),NECⅡ/Ⅲ期发生率较高(χ^(2)=15.528、5.724、6.722、10.910、5.668,均P<0.05);NEC的首发症状主要为腹胀191例(65.63%),便血56例(19.24%),呕吐47例(16.15%);NEC的治愈/好转247例(84.88%),死亡5例(1.72%),其中Ⅰ期治愈164例(91.11%);Ⅱ期/Ⅲ期治愈/好转83例(74.77%),死亡5例(4.50%)。动态腹部超声检查共201例,对NEC诊疗有一定价值。结论:NEC由多种因素综合作用引起,动脉导管未闭可能是NEC发生的单一高危因素;NEC最常见首发症状是腹胀;NEC的分期与预后密切相关,分期越高,预后越差;腹部超声动态监测有助于NEC的早期识别及疗效判断。
Objective To analyze the clinical risk factors and prognosis of neonatal necrotizing enterocolitis(NEC),and to provide evidence for early diagnosis and prevention.Methods The clinical data of 291 neonates with NEC who received treatment in the Department of Neonatology of Kunming Children's Hospital from January 1,2015 to December 31,2018 were retrospectively analyzed.According to Bell-NEC stage,these neonates were divided into BellⅠstage group,BellⅡ/Ⅲgroup.The clinical data(including perinatal period related factors,first symptoms,clinical manifestations,complications,treatment time,surgical results and prognosis),infection index,and auxiliary examination of the two groups were analyzed.Results The proportion of neonates with NEC accounted for 1.86%(291/15645)of all neonates hospitalized in the concurrent period.Among 291 neonates included,180 were of Bell stageⅠand 111 were of Bell stageⅡ/Ⅲ.There were 34(18.9%)premature neonates in the Bell stage I group and 54(48.6%)premature neonates in the Bell stageⅡ/Ⅲgroup.There were 30(16.7%)low birth weight neonates in the Bell stageⅠgroup and 53(47.7%)low birth weight neonates in the Bell stageⅡ/Ⅲgroup.There were 73(40.6%)non breast fed neonates in the Bell stageⅠgroup and 70(63.1%)non breast fed neonates in the Bell stageⅡ/Ⅲgroup.The incidence of NEC in premature neonates,low birth weight neonates,and non breast fed neonates was very high in the Bel stageⅡ/Ⅲgroup(χ^(2)=28.825,32.534,12.212,all P<0.05).There were 39(13.40%)neonates with patent ductus arteriosus,29(9.97%)neonates with coagulation dysfunction,16(5.4%)neonates with abnormal blood glucose,47(16.15%)neonates with pathological jaundice,and 12(4.12%)neonates with gestational diabetes mellitus in the Bell stageⅡ/Ⅲgroup(χ^(2)=15.528,5.724,6.722,10.910,5.668,all P<0.05).The first symptoms of NEC were abdominal distension[191(65.63%)patients],hematochezia[56(19.24%)patients],and vomiting[47(16.15%)patients].Among 291 patients included,247(84.88%)were cured,or their symptoms were improved.In the Bell stage I group,5(1.72%)patients died,and 164(91.11%)were healed.In the Bell stageⅡ/Ⅲgroup,83(74.77%)patients were healed or their symptoms were improved,and 5(4.50%)patients died.A total of 201 patients underwent dynamic abdominal ultrasound examination,which is of certain value for the diagnosis and treatment of NEC.Conclusion NEC is caused by a variety of factors.Patent ductus arteriosus may be a single risk factor for NEC.The most common first symptom of NEC is abdominal distension.The stage of NEC is closely related to prognosis,the higher the stage,the worse the prognosis.Dynamic monitoring of NEC patients using abdominal ultrasound is conducive to early identification of NEC and judgement of curative effects.
作者
赵朋娜
胡浩
朱双燕
张焱
李杨方
Zhao Pengna;Hu Hao;Zhu Shuangyan;Zhang Yan;Li Yangfang(Department of Neonatology,Kunming Children's Hospital,Kunming 650028,Yunnan Province,China)
出处
《中国基层医药》
CAS
2021年第1期60-65,共6页
Chinese Journal of Primary Medicine and Pharmacy
关键词
小肠结肠炎
坏死性
危险因素
临床表现
分期
治疗
预后
婴儿
新生
Enterocolitis,necrotizing
Risk factors
Clinical manifestations
Staging
Treatment
Prognosis
Infant,newborn
