新生儿坏死性小肠结肠炎腹部B超表现与临床转归的关系  

Relationship between abdominal ultrasound and clinical outcome in neonatal necrotizing enterocolitis

作　　者：陈薇 

机构地区：[1]西安工会医院特诊科,陕西西安710100

出　　处：《胃肠病学和肝病学杂志》2017年第4期435-439,共5页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的探讨新生儿坏死性小肠结肠炎(neonatal necrotizing enterocolitis,NEC)腹部B超表现预测临床转归的应用价值。方法选取2013年7月-2015年1月西安工会医院收治的NEC患儿共63例,根据修正Bell-NEC分级诊断标准分为疑似组(42例)及确诊组(21例),并根据临床转归分为内科治疗组(40例)及手术组(23例)。比较患儿腹部B超与X线平片的阳性检出率、准确度、特异度、灵敏度。结果以上全部63例患者,第1次腹部超声阳性检出率(73.8%)及12 h后复查阳性检出率(79.3%)均高于X线平片(68.9%、71.4%),差异有统计学意义(P<0.05)。比较腹部B超第1次检查与复查灵敏度、特异度、准确度,差异有统计学意义(P<0.05)。在确诊组,腹部超声对肠壁积气(preumatosis vntestinalis,PI)、门静脉积气(portal venous gas,PVG)的检出率要高于X线平片,差异有统计学意义(P<0.05)。腹部超声显示肠管扩张、肠壁增厚及腹腔积液(透声差)在手术组的发生率要高于内科治疗组,差异有统计学意义(P<0.05)。腹部X线平片显示肠管扩张多见于手术组,差异有统计学意义(P<0.05)。结论腹部B超对PVG、肠管扩张检出率高于X线平片,且腹部超声无放射性损伤,可以反复检查,能直视肠道蠕动及腹腔液体等,在NEC早期诊断中,较X线平片诊断结果更确切。超声显示肠管扩张、肠壁增厚及腹腔积液在手术组的发生率高,多预示临床转归不良。其结果可以作为预测临床转归的参考指标。Objective To investigate the value of abdominal ultrasound in predicting the clinical outcome of neonatal necrotizing enterocolitis （NEC）. Methods Sixty-three NEC patients were selected from Jul. 2013 to Jan. 2015 in Xi＇ an Union Hospital. According to the revised Bell-NEC grading diagnosis standard, all patients were divided into suspected period group （42 cases） and the diagnosis period group （21 cases） ; according to the clinical outcome, all patients were divided into internal medicine cure group （40 cases） and surgical group （23 cases）. Abdominal ultrasound and the positive rate of X-ray plain film, accuracy, specific, sensitivity degrees were compared. Results In all 63 patients, the positive rates of abdominal ultrasound at the first time and after 12 hours review were higher than X-ray plain film （73.8% vs 68.9% , 79.3% vs 71.4% ）, there was statistically significant （P 〈 0.05）. The sensitivity, specificity, accuracy and sensitivity were statistically significant between the first time and 12 hours review of abdominal lutrasound （P 〈 0.05）. In diagnosis period group, detection rates of pneumatosis intestinalis （ PI）, portal venous gas （PVG） of abdominal ultrasound were higher than abdominal plain film （P 〈 0.05）. Abdominal uhrasonography showed that inci- dences of blind expansion, bowel wall thickening and peritoneal effusion （acoustic） in surgical group were higher than those in internal medicine cure group （ P 〈 0.05 ）. Abdominal plain film showed the incidence of blind expansion in surgical group was higher （P 〈 0. 05）. Conclusion Abdominal ultrasound for detection of PVG, bowel expansion is superior to X-ray plain film, and it has no radioactive injury, abdominal ultrasound in the early diagnosis of NEC is more accurate than the X-ray plain film. Ultrasound shows that incidences of blind expansion, bowel wall thickening and peritoneal effusion in the surgical group are high, and poor clinical outcome. The result can be used as refere

关 键 词：坏死性小肠结肠炎 超声检查 X线 早产 新生儿 

分 类 号：R574.5[医药卫生—消化系统]