摘要
目的:探讨新生儿坏死性小肠结肠炎(neonatal necrotizing enterocolitis,NEC)的发病危险因素以及外科治疗预后的影响因素。方法:对2005年6月至2015年12月我院接收的59例新生儿NEC患儿以及80例非肠道疾病住院新生儿患者的临床资料进行回顾性分析,对影响NEC发病的危险因素进行单因素及多因素logistic回归分析;同时对59例NEC患儿根据预后情况分成2组,即存活组与死亡组,对影响NEC患儿外科治疗预后的因素进行分析。结果:NEC发病单因素分析结果显示,新生儿NEC的发病与产时窒息、产前使用糖皮质激素、感染肺炎、合并呼吸衰竭、感染性休克、弥漫性血管内凝血、发病前输注红细胞、脐静脉置管、出生后吸氧、低钙血症、低钠血症、败血症、口服益生菌、发病前喂养有关;NEC发病多因素logistic回归分析结果显示,感染肺炎、败血症、脐静脉置管是诱发NEC的高危因素(OR=2.976~5.352,P<0.05),产前使用糖皮质激素、发病前喂养、益生菌是NEC的独立保护因素(OR=0.435~0.605,P<0.05);外科治疗预后因素分析结果显示,NEC患儿出现循环衰竭、≥3处穿孔、感染性休克、代谢性酸中毒、低体质量,预后越差(P<0.05)。结论:NEC的发病与多种因素密切相关,通过控制NEC的高危因素、增加保护因素可减少NEC的发病;影响NEC外科治疗预后的因素同样众多,如循环衰竭、≥3处穿孔、低体重儿等,对于易诱发不良预后的因素应给予积极的防治措施,以改善患儿预后,提高其存活率。
Objective：To explore risk factors of neonatal necrotizing enterocolitis （NEC） and prognostic factors of surgical treatment. Methods：A retrospectively study was conducted on the clinical data of 59 cases of NEC and 80 neonatal patients with non intestinal diseases who admitted to our hospital from June 2005 to December 2015. Single-factor and multi-factors logistic regression analysis were performed to analyze the risk factors of NEC. Meanwhile, 59 NEC cases with surgical treatment were subdivided into survival and death according to the prognosis, in order to analyze the factors affecting the postoperative prognosis. Results：Single-factor analysis showed that the incidence of NEC having relationship with perinatal asphyxia,antenatal glucocorticoids,pneumonia,respiratory fail- ure,septic shock,disseminated intravascular coagulation,transfusion of red blood cells before onset,umbilical vein catheterization, postnatal oxygen inhalation, hypocalcemia, hyponatremia, sepsis, oral probiotics, pre-onset feeding. The incidence of NEC multi-factors logistic regression analysis showed that pneumonia, sepsis, umbilical vein catheterization were high risk factors of NEC （OR=2.976 to 5.352,P〈0.05）, and antenatal glucocorticoids ,pre-onset feeding, probiotics were independent protective factors of NEC （OR=0.435 to 0.605,P〈0.05）. Postoperative prognosis factor analysis showed that NEC cases who had circulatory failure, ≥3 perforation, septic shock, metabolic acidosis,low birth weight tended to have poorer prognosis（P〈0.05）. Conclusion：The incidence of NEC is closely re- lated to many factors. It can be reduced by controlling the risk factors of NEC and increasing the protective factors. Here are various factors influencing prognosis of surgical treatment including circulatory failure, ≥ 3 perforations and low birth weight, etc. In order to improve the prognosis and the survival rate of NEC,positive preventive method and therapy should be provided for the fac- tors those easy causing adverse prognosis.
出处
《重庆医科大学学报》
CAS
CSCD
北大核心
2017年第3期361-364,共4页
Journal of Chongqing Medical University
关键词
新生儿坏死性小肠结肠炎
危险因素
外科治疗
预后
neonatal necrotizing enteroeolitis
risk factors
surgical treatment
prognosis
作者简介
曾德峰，Email：zengdfl210@sina．cn．研究方向：儿童胃肠新生儿外科。
谭忠友，Email：myh01210@sina．com。
