新生儿坏死性小肠结肠炎手术介入治疗的相关分析  

Analysis of surgical interventional treatment for neonatal necrotizing enterocolitis

作　　者：高利华 王杨[1] 汪莉[1] GAO Lihua;WANG Yang;WANG Li.(Department of Pediatric,the First Affiliated Hospital of Anhui Medical University, Hefei 234000,Chin)

机构地区：[1]安徽医科大学第一附属医院新生儿科,安徽合肥234000

出　　处：《西北国防医学杂志》2018年第6期382-385,共4页Medical Journal of National Defending Forces in Northwest China

摘　　要：目的:分析新生儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)手术介入治疗的高危因素及预后。方法:回顾性分析2013-01~2017-12我院新生儿重症监护室收治的60例NEC患儿的临床资料。根据是否需要手术治疗分为手术组(n=30)和非手术组(n=30)。比较两组患儿的一般资料、并发症、临床症状、实验室检查结果、腹部X线表现、治疗方法、预后等。结果:非手术组4例保守治疗1~4d家属放弃治疗。手术组消化道穿孔20例,多处穿孔(≥3处)11例;痊愈21例,死亡9例。Ⅰ期吻合5例,造瘘25例。术后并发症8例。两组的呼吸窘迫综合征发生率、肠鸣音消失比例、C-反应蛋白(CRP)及血小板计数(PLT)水平、血培养阳性比例、X线表现为气腹门静脉积气、肠壁积气和固定肠绊比例比较,差异有统计学意义(P<0.05)。手术组患儿预后因素分析显示,治愈患儿的多处穿孔率及循环衰竭率显著低于死亡患儿,差异有统计学意义(P<0.05)。结论:NEC手术介入治疗的高危因素是多方面的;手术的预后与肠道病变及是否合并循环衰竭有关。Objective：To analyze the risk factors and prognosis of surgical intervention treatment for necrotizing enterocolitis（NEC）.Methods：Sixty newborns with NEC admitted in intensive care unit from January 2013 to December 2017 were retrospectively analyzed.According to whether or not needing surgery,they were divided into surgical group（n=30）and non-surgical group（n=30）.General data,complication,clinical symptom,laboratory results,abdominal X-ray findings,treatment methods,prognosis were analyzed.Results：Four patients gave up treatment after treated with conservative treatment for 1-4 days in non-surgical group.There were 20 cases of perforation of digestive tract and 11 cases of perforation（≥3 sites）,and 21 cases were cured,9 died in surgical group.PhaseⅠanastomosis was found in 5 cases,and fistula was found in 25 cases.Postoperative complications included 8 cases.Incidence of respiratory distress syndrome（RDS）,proportion of disappearance of bowel sounds,level of C-reactive protein（CRP）and platelet count（PLT）,positive ratio of blood cultures,and X-ray findings of pneumoperitoneum and fixed intestine were statistically significant between the two groups（P〈0.05）.The analysis of prognostic factors in the surgical group showed that the perforation rate and circulatory failure rate in the cured children were significantly lower than those in the died children（P〈0.05）.Conclusion：The risk factors for interventional treatment of NEC are multifactorial,the prognosis of surgery is related to intestinal lesions and whether complications are associated with circulatory failure.

关 键 词：坏死性小肠结肠炎 新生儿 手术介入 高危因素 预后 

分 类 号：R725.7[医药卫生—儿科]