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：薛蕊 张娟娟 李占魁 郭金珍 张敏 向磊 乔艳梅 Xue Rui;Zhang Juanjuan;Li Zhankui;Guo Jinzhen;Zhang Min;Xiang Lei;Qiao Yanmei(Department of Neonatology,Northwest Women's and Children's Hospital,Xi'an 710061,China;Department of Neonatology,Shenmu Hospital,Yulin 719300,China)

机构地区：[1]西北妇女儿童医院新生儿科,西安710061 [2]陕西省神木市医院新生儿科,榆林719300

出　　处：《中华新生儿科杂志（中英文）》2023年第7期429-432,共4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危险因素。方法选择2015年1月至2022年5月西北妇女儿童医院新生儿重症监护病房收治并手术确诊的新生儿胃穿孔患儿进行回顾性研究,总结患儿临床表现、辅助检查、手术治疗及预后等情况。根据患儿结局分为存活组和死亡组,探讨死亡危险因素。结果共纳入27例胃穿孔患儿,男17例,女10例;早产儿24例,足月儿3例;低出生体重儿26例。有窒息复苏史3例,发病前正压辅助通气10例,消化道畸形2例,术前合并感染性休克3例;发病日龄中位数2.0 d。首发症状主要为腹胀,穿孔部位多数在胃大弯,其中先天性胃壁肌层缺损20例。存活21例,死亡6例,死亡组发病日龄晚于存活组[2.5(2.0,7.8)d比1.9(1.4,3.0)d],术前血小板计数低于存活组[(126±73)×10^(9)/L比(218±80)×10^(9)/L],术前有血小板减少、感染性休克、多器官功能障碍综合征比例高于存活组,差异均有统计学意义(P<0.05)。logistic回归分析显示,术前血小板减少是新生儿胃穿孔死亡的危险因素(OR=19.000,95%CI 2.029~177.932,P=0.010)。结论新生儿胃穿孔好发于男婴、早产儿和低出生体重儿,最常见的病因为先天性胃壁肌层缺损,病死率高,术前血小板减少是死亡的危险因素。Objective To study the clinical characteristics of neonatal gastric perforation(NGP)and risk factors of mortality.Methods From January 2015 to May 2022,infants with NGP admitted to NICU of our hospital were retrospectively studied.They were assigned into the survival group and the death group.Clinical manifestations,laboratory and imaging results,surgical treatments and prognosis were compared and risk factors of mortality were determined.Results A total of 27 infants with NGP were enrolled,including 17 males and 10 females.24 were premature infants and 3 were term infants.26 infants had low birth weight.3 infants had neonatal resuscitation due to asphyxia,10 received positive pressure ventilation before the onset of perforation symptoms,2 showed gastrointestinal malformations and 3 with septic shock before surgery.The median age of onset was 2.0 d.The main presenting symptom was abdominal distension,with most perforations occurring at the greater curvature of the stomach.20 cases had congenital gastric muscular layer defects.21 cases survived and 6 cases died.Age of onset was later in the death group than the survival group[2.5(2.0,7.8)days vs.1.9(1.4,3.0)days].The survival group had higher preoperative platelet count than the death group[(218±80)×10^(9)/L vs.(126±73)×10^(9)/L].The incidences of thrombocytopenia,septic shock and multi-organ dysfunction syndrome before surgery in the survival group were significantly lower than the death group(P<0.05).Logistic regression analysis showed that preoperative thrombocytopenia was a risk factor for NGP mortality(OR=19.000,95%CI 2.029-177.932,P=0.010).Conclusions NGP is more common in male infants,premature infants and low birth weight infants.The most common etiology is congenital gastric muscular layer defects.The mortality rate is high and preoperative thrombocytopenia is a risk factor for mortality.

关 键 词：新生儿 胃穿孔 预后 危险因素 

分 类 号：R722.1[医药卫生—儿科]