新生儿气腹症72例临床特点及预后分析  

The clinical features and prognosis of pneumoperitoneum in 72 neonatal cases

作　　者：李海静[1] 陈尚勤[1] 林振浪[1] 

机构地区：[1]温州医学院附属育英儿童医院新生儿科,温州325027

出　　处：《中国新生儿科杂志》2010年第2期80-82,共3页Chinese Journal of Neonatology

摘　　要：目的探讨新生儿气腹症的临床特点和影响其预后的相关因素,以指导临床对新生儿气腹症的救治。方法回顾性分析本院2000年1月至2009年6月新生儿气腹症的临床资料。对早产、原发疾病、就诊时间、手术时间等与预后相关的因素进行Logistic回归分析。结果共72例气腹症,腹胀、呕吐为其早期和常见症状,腹壁发红及红肿高度提示气腹症,及时腹部直立位X线检查和腹腔穿刺有助诊断;手术治疗64例,其中62例为消化道穿孔,2例为非消化道穿孔,8例放弃治疗出院;手术患儿中治愈37例,治愈率57.8%;死亡27例,病死率42.2%。不同原发疾病病死率不同,以坏死性小肠结肠炎病死率最高,达78.3%。对死亡的危险因素进行Logistic多元回归分析,手术时间(P<0.05)、早产(P<0.05)、多脏器功能受损(P<0.01)、坏死性小肠结肠炎(P<0.01)是死亡的相关危险因素。发病24h内手术者疗效较佳(P<0.01)。结论新生儿气腹症中绝大多数为消化道穿孔性气腹,病死率高,死亡危险因素包括手术时间、早产,坏死性小肠结肠炎、多脏器功能受损等,早期诊断和早期治疗可改善预后。Objective To study the clinical features and prognostic factors of neonatal pneumoperitoneum in order to guide the clinical treatment. Methods The clinical data of 72 neonatal pneumoperitoneum cases admitted to our hospital from January 2000 to June 2009 were analyzed retrospectively. The relationships between prognosis and risk factors such as premature infant,primary disease,initial treatment time,and operation time were logistic regression analyzed. Results In the 72 cases,early and common symptoms of pneumoperitoneum were bloating and vomiting. Also,abdominal swelling and redness highly indicated pneumoperitoneum. Examinations by timely X-rays and peritoneocentesis led to diagnosis. There were 64 cases that received surgical treatment,62 cases of which were digestive tract perforation and 2 cases of non-digestive tract perforation. Eight cases refused surgical treatment. Within the 64 surgical cases,37 cases were cured,a curative rate of 57.8%; death resulted in 27 cases,a mortality rate of 42.2%. Necrotizing enterocolitis is the highest primary disease reaching 78.3% in mortality. Logistic regression analysis indicated that operative time （P〈0.05）,preterm infant （P〈0.05）,multiple organ dysfunction （P〈0.01）,and necrotizing enterocolitis （P〈0.01） associated with fatality. Timely operation within 24 hours had significantly higher efficacy rates than later surgery （P〈0.01）. Conclusion The majority of neonatal pneumoperitoneum is due to the perforation of digestive tract and has a high mortality rate. The risk factors of poor prognosis include operative time,prematurity,necrotizing enterocolitis,multiple organ dysfunction,etc. Early diagnosis and early treatment can improve the prognosis.

关 键 词：气腹 诊断 预后 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]