新生儿坏死性小肠结肠炎临床特点及预后不良危险因素多中心研究  

A multicenter study on the clinical features and risk factors of poor prognosis in neonatal necrotizing enterocolitis

作　　者：蔡岳鞠 瞿柳红[2] 李薇 冯雪[4] 马丽亚[5] 杨冰岩[6] 王萍 唐娟 袁伟明 李雁彬 陈晓文 张喆 赵宁 黄晓虹 陶莉 魏谋 苏衡 邓伟驰 何康成 王义桐 冯晋兴[4] 高镝[4] 黄艳[5] 周伟 Cai Yueju;Qu Liuhong;Li Wei;Feng Xue;Ma Liya;Yang Bingyan;Wang Ping;Tang Juan;Yuan Weiming;Li Yanbin;Chen Xiaowen;Zhang Zhe;Zhao Ning;Huang Xiaohong;Tao Li;Wei Mou;Su Heng;Deng Weichi;He Kangcheng;Wang Yitong;Feng Jinxing;Gao Di;Huang Yan;Zhou Wei(Department of Neonatology,Guangzhou Wowen and Children's Medical Center,Guangzhou 510120,China;Department of Neonatology,Guangzhou Huadu District Maternal and Child Health Care Hospital,Guangzhou 518000,China;Department of Neonatology,Taiping People's Hospital of Dongguan,Dongguan 523900,Guangdong Province,China;Department of Neonatology,Shenzhen Children's Hospital,Shenzhen 518026,Guangdong Province,China;Department of Neonatology,Shenzhen Baoan District Maternal and Child Health Hospital,Shenzhen 518133,Guangdong Province,China;Department of Neonatology,Boai Hospital of Zhongshan,Zhongshan 528402,Guangdong Province,China)

机构地区：[1]广州市妇女儿童医疗中心新生儿科,510120 [2]广州市花都区妇幼保健院新生儿科,518000 [3]东莞市太平医院新生儿科,523900 [4]深圳市儿童医院新生儿科,518026 [5]深圳市宝安区妇幼保健院新生儿科,518133 [6]中山市博爱医院新生儿科,528402

出　　处：《中华实用儿科临床杂志》2019年第1期24-29,共6页Chinese Journal of Applied Clinical Pediatrics

基　　金：广州市科技计划项目(1563000673).

摘　　要：目的探讨新生儿坏死性小肠结肠炎(NEC)的临床特点及预后不良的危险因素。方法采用回顾性病例研究方法,收集广东省6家医院2005年1月至2014年12月收治的NEC患儿资料,对早产儿和足月儿、早发型与晚发型NEC的临床特点及预后不良的危险因素进行分析。结果研究期间共有449例符合入选标准患儿,病死率为23.6%(106/449例),其中早产儿组为24.6%(58/238例),足月儿组为22.7%(48/211例),早发型组为22.1%(45/204例),晚发型组为24.3%(57/235例);早产儿NEC发病时间中位数为出生后11 d,足月儿NEC为出生后6 d;足月儿NEC更多表现为腹胀(52.1%比42.0%,χ^2=4.597,P=0.032)、呕吐(36.5%比17.2%,χ^2=21.428,P=0.000)、血便(30.3%比21.4%,χ^2=4.653,P=0.031),症状明显,而早产儿NEC初期则主要表现为喂养不耐受(21.0%比12.8%,χ^2=5.309,P=0.021);足月儿早发型NEC组中病例大多为双胎或多胎(9.4%比1.1%,χ^2=6.226,P=0.013),并且手术治疗率更高(41.0%比27.0%,χ^2=4.395,P=0.036),足月儿早发型NEC发生前母乳喂养率低于晚发型,差异有统计学意义(14.5%比32.6%,χ^2=9.500,P=0.002);早产儿早发型NEC组病例的出生胎龄以及出生体质量均较晚发型大[(33.8±2.5)周比(32.2±2.8)周,t=4.261,P=0.000]、[(2.1±0.5) kg比(1.7±0.5) kg,t=4.619,P=0.000],住院天数少于晚发型(18 d比26.5 d,t=4.735,P=0.000),差异均有统计学意义;Logistic回归分析显示,足月儿NEC预后不良的危险因素为休克、腹膜炎及脓毒症;早产儿NEC预后不良的危险因素为小于胎龄儿、肺出血、休克、肠穿孔、脓毒症;足月儿早发型NEC组预后不良的危险因素为休克,晚发型组为休克、腹膜炎;早产儿早发型NEC组预后不良的危险因素为休克、脓毒症,晚发型组为肺出血、休克、肠穿孔、脓毒症。结论与早产儿比较,足月儿NEC的发病时间更早,临床表现更典型;早期识别并处理休克、腹膜炎、肠穿孔、脓毒症及肺出血可降低新生儿NEC预后不良的风Objective To explore the clinical features and risk factors of poor prognosis in neonatal necrotizing enterocolitis(NEC). Methods A retrospective study was carried out in the infants with NEC admitted to 6 cooperative hospitals in Guangdong Province between January 2005 and December 2014.The clinical features and risk factors of poor prognosis in preterm and full-term infants diagnosed NEC, early onset and late onset NEC were analyzed. Results A total of 449 cases who met the criteria were admitted during the study time.The mortality was 23.6% (106/449 cases), of which the preterm group was 24.6% (58/238 cases) while the full-term group was 22.7% (48/211 cases), the early onset group was 22.1% (45/204 cases) while the late onset group was 24.3% (57/235 cases). The median number of NEC onset in preterm group was 11 d after birth while the number of the full-term group was 6 d. Full-term infants who diagnosed NEC were more likely to manifest themselves as abdominal distension(52.1% vs.42.0%, χ^2=4.597, P=0.032), vomiting(36.5% vs.17.2%, χ^2=21.428, P=0.000) and bloody stool(30.3% vs.21.4%, χ2=4.653, P=0.031);but in the onset of NEC, preterm infants more likely to have feeding intolerance(21.0% vs.12.8%, χ^2=5.309, P=0.021). The early onset group of full-term NEC was much common in twins or multiplets(9.4% vs.1.1%, χ^2=6.226, P=0.013), which rate of surgical therapy was much higher(41.0% vs.27.0%, P=0.036) and the breast-feeding rate before NEC was lower than the late onset group(14.5% vs.32.6%, χ2=9.500, P=0.002), the differences were statistically significant.The gestational age and birth weight were bigger in the early onset group of preterm NEC[(33.8±2.5) weeks vs.(32.2±2.8) weeks, t=4.261, P=0.000;(2.1±0.5) kg vs.(1.7±0.5) kg, t=4.735, P=0.000)], but length of stay was shorter than the late onset group(18.0 d vs.26.5 d, P=0.000). Logistic regression analysis showed that the risk factors of poor prognosis of full-term NEC were shock, peritonitis and sepsis;while risk factors of poor prognosis of preter

关 键 词：坏死性小肠结肠炎 婴儿 新生 临床特点 预后 危险因素 

分 类 号：R722.1[医药卫生—儿科]