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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

28卷

期数:

2022年03期

页码:

301-304

栏目:

临床医学

出版日期:

2022-05-20

文章信息/Info

Title:

Etiology and prognostic risk factors of gastrointestinal perforation in preterm neonates

文章编号:

1006-8147(2022)03-0301-04

作者:

吴晓霞¹; 2; 任红霞²; 詹江华³@

（1.天津医科大学研究生院，天津300070；2.山西省儿童医院外科，太原030013；3.天津市儿童医院普通外科， 天津300134）

Author(s):

WU Xiao-xia¹; REN Hong-xia²; ZHAN Jiang-hua³

（1.Graduate College，Tianjin Medical University，Tianjin 300070，China; 2.Department of Pediatric Surgery，Children's Hospital of Shanxi Province，Taiyuan 030013，China；3.Department of Pediatric Surgery，Tianjin Children's Hospital，Tianjin 300134，China ）

关键词:

早产儿; 消化道穿孔; 病因; 预后; 危险因素

Keywords:

premature;  gastrointestinal perforation;  etiology;  prognosis;  risk factors

分类号:

R726.5

DOI:

-

文献标志码:

A

摘要:

目的：探讨早产儿消化道穿孔的病因，分析影响早产儿消化道穿孔短期预后不良的危险因素。方法：回顾性分析山西省 儿童医院新生儿外科2015年1月—2021 年5月诊治的89 例早产儿消化道穿孔的临床资料。根据术后3 个月时结局分为生存 组和预后不良组。比较两组术前、术中及术后与早产儿消化道穿孔预后不良相关的因素，采用Logistic 回归分析筛选早产儿消 化道穿孔预后不良的危险因素。结果：早产儿消化道穿孔的病死率为25.84%，坏死性小肠结肠炎（NEC）和胃壁肌层缺损是早产 儿消化道穿孔常见的病因。单因素分析显示生存组患儿从发现气腹至手术时间在8 h 之内的比例显著高于预后不良组 （χ2=15.22，P＜0.01）。预后不良组合并脓毒性休克的比例显著高于生存组（χ2=33.19，P＜0.01）。预后不良组术后合并需非计划二次 手术的并发症比例显著高于生存组（χ2=7.24，P＜0.01）。Logistic 回归分析显示脓毒性休克（OR=0.06，95%CI：0.02~0.21，P＜0.01）和 气腹至手术时间大于8 h（OR=0.23，95%CI：0.07~0.81，P＜0.05）是早产儿消化道穿孔短期预后不良的危险因素。结论：NEC 和胃 壁肌层缺损是早产儿消化道穿孔的主要病因，脓毒性休克和从气腹发生至手术时间大于8 h 是早产儿消化道穿孔短期预后 不良的危险因素。

Abstract:

Objective：To investigate the etiology of gastrointestinal perforation in preterm neonates and to explore the risk factors for poor short-term prognosis. Methods: The clinical data of 89 cases of gastrointestinal perforation in preterm neonates treated in Children's Hospital of Shanxi Province from January 2015 to May 2021 were analyzed retrospectively. They were divided into survival group and poor prognosis group according to the outcome at 3 months postoperation. The factors may be related to the poor prognosis of gastrointestinal perforation in preterm neonates before，during and after operation were compared between the two groups. Logistic regression analysis was used to screen the risk factors of poor prognosis of gastrointestinal perforation in preterm neonates. Results: The mortality of gastrointestinal perforation in preterm neonates was 25.84%. Necrotizing enterocolitis（NEC）and congenital defects of gastric musculature were major causes of gastrointestinal perforation in preterm neonates. Univariate analysis showed that the proportion of patients operated within 8 hours after the discovery of pneumoperitoneum in survival group was significantly higher than that in poor prognosis group （χ2=15.22，P＜0.01）. The proportion of septic shock in the poor prognosis group was significantly higher than survival group（χ2=33.19，P＜0.01）. The incidence of complications requiring unplanned secondary operation was higher in the poor prognosis group than that in the survival group （χ2=7.24，P＜0.01）. Logistic regression analysis showed that septic shock（OR=0.06，95%CI：0.02-0.21，P＜0.01）andmore than 8 hours from pneumoperitoneum to operation（OR=0.23，95%CI：0.07-0.81，P＜0.05）were risk factors for poor short-term prognosis of gastrointestinal perforation in preterm neonates. Conclusion: NEC and congenital defects of gastric musculature are common causes of gastrointestinal perforation in premature neonates. Septic shock and more than 8 hours from pneumoperitoneum to operation are risk factors for poor shortterm prognosis of gastrointestinal perforation in premature neonates.

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备注/Memo

备注/Memo:

基金项目山西省重点研发计划项目（201803D31181）
作者简介:吴晓霞(1981-)，女，副主任医师，博士在读，研究方向：先 天性消化道畸形和肝胆畸形的病因及诊治；
通信作者: 詹江华， E-mail:zhanjianghuatj@163.com。

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更新日期/Last Update: 2022-06-01