新生儿坏死性小肠结肠炎危险因素临床分析  

Clinical analysis of risk factors of neonatal necrotizing enterocolitis

作　　者：陆妹[1] 朱小瑜[2] 刘登礼[3] 陆亚东[4] 贲晓明[5] 

机构地区：[1]南方医科大学附属小榄人民医院儿科,中山528415 [2]南方医科大学附属深圳妇幼保健院新生儿科 [3]厦门大学附属第一医院儿科 [4]南京医科大学附属南京儿童医院新生儿科 [5]上海市第一妇婴保健院新生儿科

出　　处：《中国新生儿科杂志》2012年第6期382-385,共4页Chinese Journal of Neonatology

摘　　要：目的探讨新生儿坏死性小肠结肠炎(NEC)发病的危险因素。方法回顾性分析2008—2011年3家医院新生儿重症监护病房收治的NEC患儿(观察组)及非NEC患儿(对照组)的临床资料,包括产科因素、产时情况、新生儿一般情况、NEC发病前疾病情况及有无应用益生菌等28个项目,应用SAS软件进行单因素和多因素分析。结果观察组92例,对照组130例,两组胎龄和出生体重差异均无统计学意义(P>0.05)。单因素分析显示,观察组产时窒息、肺炎、呼吸衰竭、生后吸氧、败血症、感染性休克、弥漫性血管内凝血、低钠血症和低钙血症的比例高于对照组,产前应用糖皮质激素、发病前喂养、高胆红素血症和口服益生菌的比例低于对照组,差异均有统计学意义(P<0.05),其余各项两组差异无统计学意义(P>0.05);Logistic回归分析显示,高胆红素血症(OR=0.205)和口服益生菌(OR=0.056)为新生儿NEC的保护因素,肺炎(OR=3.645)和败血症(OR=7.826)为危险因素。NEC组患儿发病前喂养率明显低于对照组(OR=0.072,95%CI0.010～0.501,P<0.01)。结论肺炎、败血症是新生儿NEC发病的危险因素,高胆红素血症、口服益生菌是新生儿NEC发病的保护因素,发病前喂养率低与基础疾病致延迟开奶有关。Objective To investigate risk factors of neonatal necrotizing enterocolitis （NEC）. Methods Clinical data of 92 infants with NEC （NEC group） and 130 infants without NEC （control group） from three neonatal intensive care units during January 2008 to December 2011 were collected. Single and multiple factor analysis were performed on 28 conditions including maternal risk factors during pregnancy, the presence of hypoxia and acid-base disturbance, the general health condition and disease complications of the neonate, the usage of probiotics, and the interventions received prior to the development of NEC. Results There were no significant difference of gestational age and birth weight in infants of both groups （P0.05）. Single factor analysis revealed that the proportion of infants who developed asphyxia, pneumonia, respiratory failure, oxygen usage, sepsis, septic shock, disseminated intravascular coagulation, hyponatremia and hypocalcaemia were higher in the NEC group when comparing to the control group. In contrary, the proportion of antenatal glucocorticoid usage, enteral feeding before development of NEC, preventive oral probiotics usage and presence of hyperbilirubinemia were lower in the NEC group （P0.05）. Logistic regression analysis revealed that hyperbilirubinemia （OR=0.205） and oral probiotics （OR=0.056） were protective factors of NEC, whereas pneumonia （OR=3.645） and sepsis （OR=7.826） were risk factors of NEC. Although in this study, the proportion of infants who received enteral feeding was significantly lower in the NEC group （OR=0.072）, we believe was due to delayed enteral feeding in severely ill neonates. ConclusionsHyperbilirubinemia and oral probiotics are protective factors of NEC, whereas pneumonia and sepsis are risk factors of NEC in newborns. The decreased likely hood of feeding prior to NEC was likely due to delayed initiation of enteral feeding in critically ill newborns.

关 键 词：小肠结肠炎 坏死性 危险因素 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]