新生儿胃扭转的临床特征与诊治  

Clinical characteristics and treatment of gastric volvulus in neonates

作　　者：程晓琴 杨勇 叶素芬 梅家平 Cheng Xiaoqin;Yang Yong;Ye Sufen;Mei Jiaping(Department of Neonatology,Shenzhen Maternity and Child Healthcare Hospital,the First School of Clinical Medicine,Southern Medical University,Shenzhen 518028,China)

机构地区：[1]南方医科大学第一临床医学院深圳市妇幼保健院新生儿科,深圳518028

出　　处：《中华新生儿科杂志（中英文）》2024年第6期349-353,共5页Chinese Journal of Neonatology

基　　金：广东省高水平临床重点专科,深圳市配套建设经费(SZGSP009)。

摘　　要：目的总结新生儿胃扭转的临床特征与诊治情况,探讨早期识别及治疗的方法。方法回顾性收集2015年1月至2022年6月深圳市妇幼保健院收治的新生儿胃扭转患儿的临床资料,分析其临床特征及诊治情况。结果共纳入30例新生儿胃扭转患儿,男14例,女16例,胎龄23^(+6)~42^(+5)周,中位确诊时间为发病后5.0 d(范围2~241 d)。胎龄越小,发病到确诊时间越长(P=0.003)。30例均表现为频繁喂奶后呕吐,26例(86.7%)为生后3 d内发病。14例患儿可查阅到腹部X线片,可见与上消化道造影对应的胃双泡影或胃泡水平扩张。30例患儿均予头部抬高、右侧卧位或右侧前倾卧位,多于1~2 d内明显好转。1例合并胃食管反流及反复吸入性肺炎,予改变体位及空肠喂养后好转。结论当新生儿同时出现开奶后频繁餐后吐奶及腹部X线片示胃双泡影或胃水平面扩张时,需警惕胃扭转,予右侧前倾卧位后若呕吐好转,可减少上消化道造影的辐射暴露;合并严重胃食管反流者,可结合空肠喂养,以减少手术治疗。Objective To study the clinical characteristics,diagnosis and treatment of neonatal gastric volvulus(GV)for early identification and better treatment.Methods From January 2015 to June 2022,clinical data of neonatal GV patients treated in our hospital were retrospectively collected and their clinical characteristics,diagnosis and treatment were analyzed.Results A total of 30 cases were reviewed,including 14 males and 16 females with gestational age(GA)of 23^(+6)-42^(+5)weeks.The median time from symptom onset to diagnosis was 5 d(range 2-241 d).The smaller the GA,the longer time needed from onset to diagnosis(P=0.003).All 30 cases showed frequent vomiting after feeding and 26 cases(86.7%)developed symptoms within 3 d after birth.Abdominal X-rays were reviewed after upper gastrointestinal(GI)contrast imaging in 14 cases,revealing gastric double-bubble signs or stomach dilation.All 30 patients were treated with head elevation,right lateral decubitus or right prone with upper body on-the-pillow position,showing significant improvement within 1-2 d.1 case had concomitant gastroesophageal reflux(GER)and recurrent aspiration pneumonia,and improved after body position changes and jejunal feeding.Conclusions GV should be considered in newborns with frequent post-feeding vomiting and gastric double-bubble signs or stomach dilation on abdominal X-rays.Radiation from upper GI imaging may be reduced if vomiting improves after right anterior tilting position.For neonates with comorbidity of severe GER,jejunal feeding may be added to minimize the need for surgical treatment.

关 键 词：胃扭转 新生儿 早期识别 呕吐 诊断 治疗 

分 类 号：R722.1[医药卫生—儿科]