新生儿坏死性小肠结肠炎肠狭窄相关因素分析  

Analysis of risk factors for intestinal stenosis after neonatal necrotizing enterocolitis

作　　者：夏仁鹏[1] 邹婵娟[1] 赵凡[1] 马体栋[1] 肖咏 彭琨 许光[1] 李碧香[1] 周崇高[1] Xia Renpeng;Zou Chanjuan;Zhao Fan;Ma Tidong;Xiao Yong;Peng Kun;Xu Guang;Li Bixiang;Zhou Chonggao(Department of Neonatal Surgery,Hunan Children's Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院新生儿外科,长沙410007

出　　处：《临床小儿外科杂志》2022年第4期320-324,共5页Journal of Clinical Pediatric Surgery

基　　金：湖南省出生缺陷协同防治科技重大专项(2019SK1010)。

摘　　要：目的探讨新生儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)肠狭窄的相关因素。方法回顾性分析2013年1月至2018年1月湖南省儿童医院新生儿外科收治的NEC肠狭窄患儿(肠狭窄组)及同期收治的无肠狭窄NEC患儿(无肠狭窄组)的临床资料。统计两组患儿性别、胎龄、出生体重、生产方式、呼吸机使用情况、喂养情况、血液制品输注情况、检验及检查结果、预后等;同时收集母亲受孕方式,孕期宫内窘迫、胎膜早破,母亲合并高血压、糖尿病以及是否使用激素等情况,并进行对比分析。结果本研究共纳入132例NEC患儿,其中肠狭窄组65例,无肠狭窄组67例。两组在一般情况、母亲受孕方式、母孕期情况、是否手术以及检查结果方面比较,差异均无统计学意义(P>0.05)。肠狭窄组患儿起病日龄[8.0(6.0,14.0)d]大于无肠狭窄组[5.0(3.0,8.0)d],差异有统计学意义(P<0.001);两组白细胞计数和中性粒细胞比率比较,差异无统计学意义(P=0.135、0.486);血小板计数、血清白蛋白(g/L)比较,差异也无统计学意义(P=0.283、0.632)。肠狭窄组C反应蛋白[(71.54±39.14)mg/L]高于无肠狭窄组[(48.95±49.61)mg/L],P=0.004;降钙素原[(11.91±14.60)ng/mL]高于无肠狭窄组[(6.14±8.38)ng/mL],P=0.006。Logistic回归分析结果显示,起病日龄[OR值=1.115、95%CI(1.035~1.200)]、C反应蛋白[OR值=1.014,95%CI(1.005~1.024)]及降钙素原[OR值=1.039,95%CI(1.001~1.078)]是NEC肠狭窄相关因素。结论新生儿一般情况、母亲受孕方式、母孕期因素及是否手术与NEC肠狭窄无相关性。NEC起病日龄越大,发生肠狭窄的可能性越大;C反应蛋白、降钙素原升高是NEC肠狭窄的相关因素。Objective To explore the risk factors of intestinal stenosis after neonatal necrotizing enterocolitis(NEC).Methods From January 2013 to January 2018,retrospective analysis was performed for clinical data of post-NEC intestinal stenosis children and normal controls during the same period.Results A total of 132 children were assigned into tow groups of post-NEC intestinal stenosis(stenosis,n=65)and non-stenosis(control,n=67).No inter-group statistical difference existed in general neonatal status,maternal mode of conception,maternal status during pregnancy,operation or not and examination results(P>0.05).Onset age of NEC:stenosis group was greater than control group[8.0(6.0,14.0)vs.5.0(3.0,8.0)days](P<0.001);no statistical difference existed in leucocyte count or neutrophil ratio of statistical significance(P=0.135,0.486);no obvious inter-group difference existed in platelet count or serum albumin(P=0.283,0.632);C-reactive protein;stenosis group was higher than control group[(71.54±39.14)vs.(48.95±49.61)mg/L,P=0.004];Procalcitonin:stenosis group was higher than control group[(11.91±14.60)vs.(6.14±8.38)ng/mL,P=0.006].According to Logistic regression analysis,NEC's onset age[OR value=1.115,95%CI(1.035-1.200)],C-reactive protein[OR value=1.014,95%CI(1.005-1.024)]and procalcitonin[OR value=1.039,95%CI(1.001-1.078)]were risk factors for stenosis group.Conclusion General neonatal status,maternal mode of conception,maternal status during pregnancy and operation or not are correlated with post-NEC intestinal stenosis.The later onset age of NEC and the greater possibility of intestinal stenosis.And CRP and PCT are both risk factors for post-NEC stenosis.

关 键 词：小肠结肠炎 坏死性/诊断 小肠结肠炎 坏死性/外科学 缩窄 病理性 肠 手术后并发症 病例对照研究 

分 类 号：R722.1[医药卫生—儿科]