|本期目录/Table of Contents|

[1]刘娜娜,冯伟,李鑫,等.新生儿坏死性小肠结肠炎并发肠穿孔的临床特点及预后分析[J].天津医科大学学报,2021,27(02):142-146.
 LIU Na-na,FENG Wei,LI Xin,et al.Clinical characteristics and prognosis of neonatal necrotizing enterocolitis complicated with intestinal perforation[J].Journal of Tianjin Medical University,2021,27(02):142-146.
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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:
27
期数:
2021年02期
页码:
142-146
栏目:
临床医学
出版日期:
2021-03-15

文章信息/Info

Title:
Clinical characteristics and prognosis of neonatal necrotizing enterocolitis complicated with intestinal perforation
文章编号:
1006-8147(2021)02-0142-05
作者:
刘娜娜12冯伟1李鑫13王皓洁13詹江华4
(1.天津医科大学研究生院,天津 300070;2.天津市静海区医院儿科,天津301600;3.新疆乌鲁木齐儿童医院新生儿外科,乌鲁木齐 830002;4.天津市儿童医院普通外科,天津 300134)
Author(s):
LIU Na-na12FENG Wei1LI Xin13WANG Hao-jie13ZHAN Jiang-hua3
(1. Graduate School,Tianjin Medical University,Tianjin 300070,China;2. Department of Pediatrics,Jinghai District Hospital,Tianjin 301600,China;3. Department of Neonatal Surgery,Ulumuqi Children′s Hospital,Ulumuqi 830000,China;4. Department of General Surg
关键词:
坏死性小肠结肠炎肠穿孔临床特点预后新生儿
Keywords:
intestinal perforationnecrotizing enterocolitisclinical featureprognosisneonate
分类号:
R726.5
DOI:
-
文献标志码:
A
摘要:
目的:探讨新生儿坏死性小肠结肠炎(NEC)并发肠穿孔的临床特点以对其预后情况进行评估。方法:回顾性收集93例经手术治疗的NEC并发肠穿孔患儿的临床资料。根据患儿预后将其分为良好组(69例)及不良组(24例),采用单因素和多因素Logistic回归分析影响其预后的危险因素。结果:93例患儿多数为早产儿(83.9%)及低出生体重儿(80.6%),合并症以低蛋白血症(45.2%)、低钾血症(39.8%)为主,术中发现以小肠穿孔(52.7%)、单处穿孔多见(79.6%)。患儿合并低蛋白血症(OR=2.077,95%CI:1.931 ~ 31.889)、凝血功能障碍(OR=22.829,95%CI:7.063 ~ 532.608)及穿孔数目≥2处(OR=3.209,95%CI:1.623 ~ 126.806)为预后不良的独立危险因素(均P<0.05)。上述独立危险因素联合对预后不良预测的ROC曲线下面积为0.862(95%CI:0.764~0.961,P<0.001),特异性和敏感度分别为83.3%、77.1%。结论: NEC并发肠穿孔病情复杂、不良预后发生率较高,患儿合并低蛋白血症、凝血功能障碍及肠穿孔数目≥2处可为预后不良提供评估依据。
Abstract:
Objective: To explore the clinical features and prognostic evaluation of neonatal necrotizing enterocolitis(NEC) complicated with intestinal perforationand and analyze the risk factors affecting the prognosis. Methods: The clinical data of 93 patients with NEC complicated with intestinal perforation treated by surgery were collected,retrospectively. According to the prognosis of patients,they were divided into good outcome group(69 cases) and poor outcome group(24 cases),and single factor and multivariate Logistic regression were used to analyze the risk factors affecting their prognosis. Results: Most of the 93 children were born prematurely(83.9%) and low-birth weight(80.6%). Patients always accompanied by hypoproteinemia (45.2%) and hypokalemia(39.8%). During the operation,it was found that small bowel perforation(52.7%) and single perforation were more common(79.6%).The patient accompanied by hypoproteinemia (OR=2.077,95% CI:1.931-31.889),coagulation dysfunction(OR=22.829,95% CI:7.063-532.608) and the number of intestinal perforations ≥2(OR=3.209,95% CI:1.623-126.806) were independent risk factors for poor prognosis(all P<0.05). Combining the above independent risk factors to predict poor outcome,the area under the ROC curve was 0.862(95% CI:0.764-0.961),and the specificity and sensitivity were 83.3% and 77.1%,respectively. Conclusion: Children with NEC complicated by intestinal perforation have complex conditions and high incidence of poor outcome. Hypoproteinemia,coagulation dysfunction,and the number of intestinal perforations ≥2 can provide assessment basis for poor prognosis.

参考文献/References:

[1] Hackam D,Caplan M. Necrotizing enterocolitis: pathophysiology from a historical context[J]. Semin Pediatr Surg,2018,27(1):11
[2] 朱海涛.新生儿坏死性小肠结肠炎外科手术治疗专家共识[J].中华小儿外科杂志,2016,37(10):724
[3] Bisquera J A,Cooper T R,Berseth C L. Impact of necrotizing enterocolitis on length of stay and hospital charges in very low birth weight infants[J]. Pediatrics,2002,109(3):423
[4] 刘利,李秋宇,安瑶,等.早产与足月新生儿坏死性小肠结肠炎临床对比分析[J].重庆医科大学学报,2017,42(8):1006
[5] Vongbhavit K,Underwood M A. Intestinal perforation in the premature infant[J]. J Neonatal Perinatal Med,2017,10(3):281
[6] Irles C,González-Pérez G,Carrera M S,et al. Estimation of neonatal intestinal perforation associated with necrotizing enterocolitis by machine learning reveals new key factors[J]. Int J Environ Res Public Health,2018,15(11):2509
[7] Cordemans C,De Laet I,Van Regenmortel N,et al. Fluid management in critically ill patients: the role of extravascular lung water,abdominal hypertension,capillary leak,and fluid balance[J]. Ann Intensive Care,2012,2(Suppl 1):1
[8] Don B R,Kaysen G. Serum albumin:relationship to inflammation and nutrition[J]. Semin Dial,2004,17(6):432
[9] Sharif S P,Friedmacher F,Amin A,et al. Low serum albumin concentration predicts the need for surgical intervention in neonates with necrotizing enterocolitis[J]. J Pediatr Surg,2020,55(12):2625
[10] 李志金,杨赞章,李善学. 甲泼尼龙致低钾性麻痹2例[J].医药导报,2015,34(8):1117
[11] Bowker R M,Yan X,De Plaen I G. Intestinal microcirculation and necrotizing enterocolitis:the vascular endothelial growth factor system[J]. Semin Fetal Neonatal Med,2018,23(6):411
[12] 陈发玲,徐伟珏,李龙至,等. 不同病变范围新生儿坏死性小肠结肠炎手术干预效果分析[J].中华实用儿科临床杂志,2016, 31(23):1783
[13] 王雪秋,陈师,郭露,等. 新生儿坏死性小肠结肠炎与自发性肠穿孔临床对比分析[J].临床儿科杂志,2018,36(11):871
[14] 林宇,吴晓娟,黄文华,等. 新生儿坏死性小肠结肠炎和先天性巨结肠肠穿孔的鉴别诊断和治疗[J]. 中华实用儿科临床杂志,2019,
34(21):1645
[15] 中华医学会小儿外科学分会新生儿学组.新生儿坏死性小肠结肠炎小肠造瘘术后临床治疗专家共识[J].中华小儿外科杂志,2016, 37(8):563
[16] 吴书清,钟斌,刘辉,等. Bishop-Koop造瘘术和双口造瘘术在新生儿坏死性小肠结肠炎中的疗效比较[J].临床小儿外科杂志,2018,17(11):835
[17] 刘斌. 新生儿坏死性小肠结肠炎外科诊疗进展[J].中国普通外科杂志,2015,24(10):1463
[18] Hong C R,Han S M,Jaksic T. Surgical considerations for neonates with necrotizing enterocolitis[J]. Semin Fetal Neonatal Med,2018, 23(6):420
[19] Robinson J R,Rellinger E J,Hatch L D,et al. Surgical necrotizing enterocolitis[J]. Semin Perinatol,2017,41(1):70

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备注/Memo

备注/Memo:
基金项目 新疆维吾尔自治区自然科学基金(2019D01A12)
作者简介 刘娜娜(1972-),女,主任医师,硕士在读,研究方向:儿科学;通信作者,詹江华,E-mail:zhanjianghuatj@163.com。
更新日期/Last Update: 2021-03-10