新生儿中肠扭转致肠坏死的相关因素分析  

Related factors of intestinal necrosis caused by midgut volvulus in neonates

作　　者：关茜思 王哲 何秋明 郑海清 钟微 余家康 Guan Xisi;Wang Zhe;He Qiuming;Zheng Haiqing;Zhong Wei;Yu Jiakang(Department of Neonatal Surgery,Guangzhou Women and Children's Medical Center,Guangzhou 510000,China;Medical Big Date Center,Guangdong Provincial People's Hospital,Guangzhou 510000,China)

机构地区：[1]广州市妇女儿童医疗中心新生儿外科,广州510000 [2]广东省人民医院医学大数据中心,广州510000

出　　处：《中华新生儿科杂志（中英文）》2022年第3期225-228,共4页Chinese Journal of Neonatology

摘　　要：目的探讨新生儿中肠扭转致肠坏死的病例特点及发生肠坏死的相关因素。方法回顾性分析2009年1月至2019年12月广州市妇女儿童医疗中心收治并经手术确诊的新生儿中肠扭转病例资料,发生肠坏死的病例为肠坏死组,并从无肠坏死患儿中随机抽取约4倍于肠坏死组病例数的患儿为无肠坏死组,比较两组个人史、发病日龄、首发症状、入院2 h内生命体征、出现症状到手术时间、临床结局、入院2 h内实验室指标等,通过多因素Logistic回归分析筛选中肠扭转发生肠坏死的相关因素,进一步绘制受试者工作特征(receiver operating characteristic,ROC)曲线筛选有效预警指标。结果(1)231例中肠扭转患儿中,手术时已出现肠坏死21例,占9.1%(21/231),无肠坏死组共纳入87例。(2)肠坏死组入院2 h内心率、平均动脉压、白细胞、C反应蛋白、血糖及血钾水平均高于无肠坏死组(P<0.05)。入院日龄、血红蛋白、血清白蛋白、血钠、pH及BE水平均低于无肠坏死组(P<0.05)。(3)多因素分析显示,入院2 h内心率增快、平均动脉压升高、C反应蛋白升高、血钠水平降低、血清白蛋白降低、低pH为中肠扭转致肠坏死的相关因素。(4)C反应蛋白单独预测中肠扭转发生肠坏死的ROC曲线下面积为0.883,最佳切点值为9.88 mg/L,敏感度76.2%,特异度94.3%。血清白蛋白单独预测中肠扭转并坏死的ROC曲线下面积为0.792,最佳切点值为36.65 g/L,敏感度70.1%,特异度94.3%。结论心率、平均动脉压、C反应蛋白增高及血钠、血清白蛋白、pH降低对判断新生儿中肠扭转是否发生肠坏死有一定帮助,其中C反应蛋白>9.88 mg/L和血清白蛋白<36.65 g/L为较好的预警指标。Objective To study the characteristics and related factors of neonatal intestinal necrosis caused by midgut volvulus.Methods We retrospectively analyzed the clinical data of neonates with midgut volvulus who were admitted to Guangzhou Women and Children's Medical Center,from January 2009 to December 2019 and confirmed by surgery.The cases with intestinal necrosis belong to the intestinal necrosis group,and those without intestinal necrosis,the non-intestinal necrosis group which was randomly sampled at a ratio of about 4∶1 to the number of cases in the intestinal necrosis group.The two groups were compared in terms of personal history,age of onset,initial symptoms,vital signs within 2 h after admission,time from symptom onset to operation,clinical outcome,laboratory indicators within 2 h after admission,etc.Multivariate Logistic regression analysis was used to screen the related factors of intestinal necrosis in midgut volvulus.The effective warning indexes are screened by receiver operating characteristic(ROC)curve.Results(1)Among 231 cases of midgut volvulus,21 cases(9.1%,21/231)had intestinal necrosis at the time of operation,87 cases were included in the non-intestinal necrosis group.(2)The levels of heart rate within 2 h after admission,mean arterial pressure,WBC,C reactive protein(CRP),blood glucose and potassium in intestinal necrosis group were significantly higher than those in non-intestinal necrosis group(P<0.05).Admission days of age,hemoglobin,serum albumin,serum sodium,pH and BE levels were significantly lower than those in the group without intestinal necrosis(P<0.05).(3)In the multivariate analysis,increased heart rate,mean arterial pressure,serum CRP,and decreased serum sodium,serum albumin,and pH levels were predictors related to intestinal necrosis in patients with midgut volvulus.(4)The area under the ROC curve(AUC)of CRP was 0.883,the cutoff value was 9.88 mg/L,the sensitivity was 76.2%,and the specificity was 94.3%.The ROC curve of serum albumin was 0.792,the cut-off value was 36.65 g/L,th

关 键 词：中肠扭转 肠坏死 相关因素 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]