新生儿胃穿孔临床特点及死亡危险因素分析  

Clinical characteristics of neonatal gastric perforation and risk factors of mortality

作　　者：钟迪 龙芳 康朦梦 李恺[1] 张永[1] 陈运彬[1] Zhong Di;Long Fang;Kang Mengmeng;Li Kai;Zhang Yong;Chen Yunbin(Department of Neonatology,Guangdong Women and Children Hospital,Guangzhou 510000,China)

机构地区：[1]广州医科大学附属广东省妇儿医院,广东省妇幼保健院新生儿科,广州510000

出　　处：《中华新生儿科杂志（中英文）》2023年第5期278-282,共5页Chinese Journal of Neonatology

摘　　要：目的探讨新生儿胃穿孔的临床特点及死亡的危险因素。方法回顾性分析2015年1月至2021年12月广东省妇幼保健院新生儿内科和新生儿外科重症监护室收治的临床确诊胃穿孔患儿,根据预后分为存活组和死亡组,比较两组患儿临床特点,采用多因素logistic回归分析死亡危险因素。结果共纳入50例,男38例,女12例;早产儿34例,低出生体重儿30例;存在窒息史5例;存活组41例,死亡组9例。患儿主要表现为腹胀、呼吸急促、发绀、反应差、发热、肠鸣音减弱、腹壁潮红等,腹部X线均显示气腹,实验室检查主要表现为血白细胞升高或降低、血小板降低、C反应蛋白及降钙素原升高、血pH降低、乳酸升高。穿孔部位主要为胃大弯(30例),大于3 cm的穿孔40例,伴肠坏死14例。部分患儿存在败血症、呼吸衰竭、肺出血、休克、凝血功能障碍等相关并发症。死亡组呼吸困难、发热、降钙素原升高、pH<7.3、肠坏死、出现症状至手术时间>24 h及有败血症、肺出血、呼吸衰竭、休克、凝血功能障碍等并发症的比例均高于存活组,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,pH<7.3(OR=9.755,95%CI 1.363~69.800)、出现症状至手术时间>24 h(OR=11.831,95%CI 1.305~107.301)和合并败血症(OR=29.622,95%CI 3.728~235.369)为新生儿胃穿孔死亡的危险因素。结论新生儿胃穿孔以腹胀、气腹为主要表现,合并败血症、pH<7.3及出现症状至手术时间>24 h提示死亡风险增加。Objective To study the clinical characteristics of neonatal gastric perforation(NGP)and risk factors of mortality.Methods From January,2015 to December,2021,clinical manifestations of neonates diagnosed with NGP in the Department of Neonatology and Neonatal Surgical Intensive Care Unit of our hospital were retrospectively analyzed.Neonates were assigned into the survival group and the death group according to their prognosis.Risk factors of mortality were analyzed using multivariate logistic regression method.Results A total of 50 cases were enrolled,including 41 in the survival group and 9 in the death group.38 cases were males,34 were premature infants,30 were low birth weight infants and 5 had history of asphyxia.The clinical manifestations included abdominal distension,tachypnea,cyanosis,poor response,fever,diminished bowel sound and redness of the abdominal wall.Abdominal X-ray indicated pneumoperitoneum.Laboratory abnormalities included leukocytosis,thrombocytopenia,elevated C-reactive protein and procalcitonin,decreased blood pH and increased lactic acid.30 cases had perforation at the greater curvature of stomach.Perforation was larger than 3 cm in 40 cases and intestinal necrosis was identified in 14 cases.Some patients suffered from sepsis,respiratory failure,pulmonary hemorrhage,shock,coagulopathy and other related complications.The death group had significantly higher incidences of dyspnea,fever,elevated procalcitonin,blood pH<7.3,intestinal necrosis,time from onset of clinical manifestations to operation(Tm-o)>24 h and complications than the survival group(P<0.05).Multivariate logistic regression analysis showed that pH<7.3(OR=9.755,95%CI 1.363-69.800),Tm-o>24 h(OR=11.831,95%CI 1.305-107.301),septic shock and sepsis(OR=29.622,95%CI 3.728-235.369)were risk factors of mortality.Conclusions The main manifestations of NGP are abdominal distension and pneumoperitoneum.The risk factors of mortality in NGP are sepsis,blood pH<7.3 and Tm-o>24 h.

关 键 词：胃穿孔 临床特点 危险因素 新生儿 

分 类 号：R722.1[医药卫生—儿科]