新生儿胃肠穿孔80例临床特点及预后分析  

Clinical features and prognosis of 80 cases of newborn gastrointestinal perforation

作　　者：陈园园[1] 张蓉[1] 朱丽[1] 王瑾[1] 曹云[1] 陈超[1] 

机构地区：[1]复旦大学附属儿科医院新生儿科,上海201102

出　　处：《中国实用儿科杂志》2017年第2期141-144,148,共5页Chinese Journal of Practical Pediatrics

摘　　要：目的分析新生儿胃肠穿孔的病因、临床特征、治疗及预后。方法回顾性分析2004年1月至2015年12月复旦大学附属儿科医院新生儿科收治的80例新生儿胃肠穿孔患儿的临床资料,根据出生胎龄分为早产儿组与足月儿组,比较两组间的病因、临床表现、治疗及预后。结果 80例新生儿胃肠穿孔中,早产儿62例,足月儿18例。两组病因均以坏死性小肠结肠炎(necrotizing enterocolitis,NEC)为主,临床均以腹胀为主要表现,早产儿发生反应差、休克、弥散性血管内凝血明显多于足月儿(P<0.05)。早产儿组平均发病日龄9(1.75,20)d,足月儿组平均发病日龄4.5(1,7.75)d。62例手术治疗,其中胃穿孔8例,肠穿孔54例,18例因未手术穿孔部位不明确。死亡32例,病死率40%,早产儿死亡26例(病死率41.9%),足月儿死亡6例(病死率33.3%)。结论新生儿胃肠穿孔是新生儿期的严重疾病,病死率高。早期诊断、积极治疗和尽早外科干预可能提高患儿的存活率,显著改善患儿的预后。Objective To compare the etiologic factors, clinical features and prognosis in newborns with gastrointestinal perforation. Methods A retrospective study of the clinical data from 80 cases with diagnosis of gastrointestinal perforation collected from January 2004 to December 2015 was performed. Based on whether they were full-term, the eases were divided into two groups, then the clinical features, etiologic factors and prognosis were compared. Results Among the 80 neonates with gastrointestinal perforation, there were 62 preterm infants and 18 full-term infants. The main causes of gastrointestinal perforation for the two groups was uecrotiziug enteroeolitis, with the most frequent clinical symptom of abdominal distension. eases. Compared with full-term infants, the incidence of preterm shock, dyspnea, DIC, and poor reaction was significantly higher in preterm infants （p 〈 0.05）.The mean time period of perforation in preterm infants group was 9 （1.75,20） d, while it was 4.5 （1, 7.75 ） d in frill-term infants group.There were 62 cases that received surgical treatment, 8 cases of which were gastric perforation and 54 cases were intestinal perforation. The exact site of perforation of the 18 cases who refused surgical treatment was not clear. Of all the cases, 32 infants died with the overall mortality rate of 40%. For the preterm infants, the mortality was 41.9% （26 cases） , while it was 33.3% （6 eases） in the full-term infants group. Conclusion Neonatal gastrointestinal perforation is one of the serious diseases in neonatal period, which has a very high mortality rate. Early di agnosis, active treatment and timely surgical intervention can significantly improve survival rates and improve the prognosis.

关 键 词：胃肠穿孔 气腹 坏死性小肠结肠炎 

分 类 号：R72[医药卫生—儿科]