胎粪性腹膜炎术后并发症及死亡原因的短期随访分析  

Short-term follow-ups of postoperative complications and causes of death in neonates with meconium peritonitis

作　　者：谷佳伟 任红霞[2] Gu Jiawei;Ren Hongxia(Department of Pediatrics,Shanxi Medical University,Taiyuan 030001,China;Department of Neonatal Surgery,Shanxi Children's Hospital,Taiyuan 030013,China)

机构地区：[1]山西医科大学儿科医学系,太原030001 [2]山西省儿童医院新生儿外科,太原030013

出　　处：《中华小儿外科杂志》2024年第1期36-40,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨胎粪性腹膜炎(meconium peritonitis,MP)术后并发症及早期死亡原因,提高对MP的认识。方法回顾性分析2011年10月至2021年11月在山西省儿童医院行手术治疗的67例MP患儿的临床资料,其中男31例,女36例。患儿手术时中位年龄为1.63(1.17,2.80)d。所有患儿随访至术后6个月,根据存活情况将其分为存活组(55例)和死亡组(12例)。分析所有患儿术后并发症发生情况及死亡组死亡原因。比较两组患儿术前、术中一般资料、是否产前诊断、是否早期手术及术后病理情况、术后并发症的差异,通过单因素分析和进一步的多因素logistic回归分析确定MP患儿早期死亡的相关因素。结果67例患儿术后共24例发生并发症,包括短肠综合征7例、不完全性肠梗阻6例、坏死性小肠结肠炎5例、造瘘口回缩或脱出2例、感染性休克2例、吻合口漏1例、败血症1例。最终12例患儿死亡,其中3例因腹腔感染、休克、多器官功能衰竭院内死亡,9例术后因出现短肠综合征4例、坏死性小肠结肠炎1例、不完全性肠梗阻1例、吻合口漏1例、造瘘口肠管脱出1例、败血症1例放弃治疗后院外死亡。死亡组术前C反应蛋白为(52.18±69.21)mg/L,高于存活组的(10.08±17.02)mg/L,差异有统计学意义(P<0.001)。死亡组术前白蛋白水平为29.90(26.78,31.38)g/L,低于存活组的32.10(28.80,35.20)g/L,差异有统计学意义(P=0.036)。两组患儿是否早期手术、是否合并短肠综合征的比例差异有统计学意义(均P<0.05)。将单因素分析中P<0.05的临床因素纳入多因素分析,结果显示术前C反应蛋白增高(OR=1.043,95%CI:1.009~1.078,P=0.012)、合并短肠综合征(OR=17.929,95%CI:1.799~178.629,P=0.014)为MP患儿死亡的危险因素;早期手术(OR=0.068,95%CI:0.006~0.709,P=0.025)为MP患儿死亡的保护因素。结论MP患儿术后主要并发症和早期死亡原因是短肠综合征、肠道炎症或梗阻,尽早手术是提高治愈率的关Objective To explore the postopetative complications and early death causes of meconium peritonitis(MP)and to improve its understanding.Methods From October 2011 to November 2021,the relevant clinical data were retrospectively reviewed for 67 MP children.There were 31 boys and 36 girls with an operative age of 1.63(1.17-2.80)days.Based upon survival status,they were assigned into two groups of survival(n=55)or death(n=12).The incidence of postoperative complications and the causes of death were examined.Perioperative profiles,prenatal diagnosis,early operation,postoperative pathology and postoperative complications were compared between two groups.Univariate and multivariate Logistic regression analyses were performed for determining the related factors of early death in MP patients.Results During a follow-up period of 6 months,postoperative complications occurred in 24/67 patients,including short bowel syndrome(n=7),incomplete intestinal obstruction(n=6),necrotizing enterocolitis(n=5),retraction/prolapse of fistula(n=2),septic shock(n=2),anastomotic leakage(n=1)and septicemia(n=1).Three deaths were due to abdominal infection,shock and multiple organ failure in hospital.And the remainders gave up treatments and died outside a hospital from short bowel syndrome(SBS,n=4),necrotizing enterocolitis(n=1),incomplete intestinal obstruction(n=1),anastomotic leakage(n=1),fistula orifice prolapse(n=1)and septicemia(n=1).The preoperative C-reactive protein(CRP)was higher in death group than that in survival group[(52.18±69.21)vs(10.08±17.02)mg/L].The inter-group difference was statistically significant(P<0.001).Preoperative level of albumin was lower in death group than that in survival group[29.90(26.78,31.38)vs 32.10(28.80,35.20)g/L].And inter-group difference was statistically significant(P=0.036).Statistically significant inter-group differences existed in the proportion of children undergoing early surgery and those complicated by SBS(all P<0.05).Clinical factors with P<0.05 in univariate analysis were included for m

关 键 词：腹膜炎 胎粪性腹膜炎 并发症 新生儿 

分 类 号：R726.5[医药卫生—儿科]