手术治疗的坏死性小肠结肠炎早产儿并发脑损伤的危险因素分析  

Risk factors for brain injury in preterm infants with surgical necrotizing enterocolitis

作　　者：徐豆豆[1] 殷小利 胡佩佩 许马利 李巍松[1] 王杨[1] Xu Doudou;Yin Xiaoli;Hu Peipei;Xu Mali;Li Weisong;Wang Yang(Department of Pediatrics,First Affiliated Hospital,Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院儿科,合肥230022

出　　处：《中华小儿外科杂志》2024年第7期613-618,共6页Chinese Journal of Pediatric Surgery

基　　金：安徽省科技厅公益技术应用研究联动计划项目(1704f0804018)。

摘　　要：目的探讨手术治疗的坏死性小肠结肠炎(necrotizing enterocolitis,NEC)早产儿并发脑损伤的危险因素。方法回顾性分析2016年1月至2022年12月安徽医科大学第一附属医院手术治疗的55例NEC早产儿临床资料,所有患儿中位发病日龄为16(12,25)d;修正Bell分期为ⅡB期17例(30.9%,17/55),Ⅲ期38例(69.1%,38/55)。依据患儿纠正胎龄近足月时的磁共振成像(magnetic resonance imaging,MRI)评分作为脑损伤的判断指标,将患儿分为MRI+组(发生脑损伤,30例)和MRI-组(未发生脑损伤,25例)。比较两组患儿术前围生期情况、临床特征、实验室检查结果、临床合并症和手术情况等。采用多因素logistic回归分析探讨手术治疗的NEC早产儿发生脑损伤的危险因素。结果MRI+组肠穿孔的发生率(66.7%,20/30)高于MRI-组(36.0%,9/25),差异有统计学意义(P=0.032)。MRI+组发病时血红蛋白水平低于MRI-组[(108.9±17.5)g/L比(129.3±24.2)g/L,P=0.001],降钙素原(procalcitonin,PCT)水平高于MRI-组[18.6(0.4,34.0)ng/ml比1.5(0.8,3.0)ng/ml,P=0.029]。MRI+组病变肠管以多病灶型或广泛病变型为主(60.0%,18/30),MRI-组以局灶型病变居多(72.0%,18/25),差异有统计学意义(P=0.018)。多因素logistic回归分析显示,发病时PCT(OR=1.108,95%CI:1.012~1.214)是手术治疗的NEC早产儿发生脑损伤的独立危险因素,血红蛋白(OR=0.955,95%CI:0.918~0.994)是保护因素。结论发病时PCT是手术治疗的NEC早产儿发生脑损伤的独立危险因素,血红蛋白是保护因素,动态监测PCT和血红蛋白水平有助于评估手术治疗NEC早产儿的神经发育结局。Objective To explore the risk factors for brain injury in preterm infants with surgical necrotizing enterocolitis(NEC).Methods From January 2016 to December 2022,retrospective analysis was performed for 55 preterm infants hospitalized with surgical NEC.Median onset age was 16(12,25)day.Bell stages wereⅡB(30.9%,17/55)andⅢ(69.1%,38/55).According to the grades of magnetic resonance imaging(MRI)at term-equivalent age,they were assigned into two groups of positive brain MRI(MRI+)(brain injury,n=30)and negative brain MRI(MRI-)(brain non-injury,n=25).Preoperative perinatal status,clinical characteristics,laboratory test results,clinical complications and surgical findings were compared between two groups.Logistic regression model was utilized for examining the risk factors for brain injury.Results The incidence of intestinal perforation was higher in MRI+group than that in MRI-group[(66.7%,20/30)vs(36.0%,9/25)]and the difference was statistically significant(P=0.032).At time of onset,hemoglobin level was lower in MRI+group[(108.9±17.5)vs(129.3±24.2)g/L,P=0.001]while procalcitonin(PCT)level was higher than that in MRI-group[18.6(0.4,34.0)vs 1.5(0.8,3.0)ng/ml,P=0.029].In MRI+group,intestines manifested multifocal or whole intestinal lesions(60.0%,18/30)while MRI-group showed focal lesions(72.0%,18/25).The difference was statistically significant(P=0.018).Multivariate logistic regression analysis revealed that PCT(OR=1.108,95%CI:1.012-1.214)was the independent risk factor for brain injury in preterm infants with surgical NEC,whereas hemoglobin was a protective factor(OR=0.955,95%CI:0.918~0.994).Conclusions PCT is the independent risk factor for brain injury in preterm infants with surgical NEC,whereas hemoglobin is a protective factor.Dynamic monitoring of PCT and hemoglobin is beneficial to assessing the neurodevelopmental surgical outcomes for NEC in premature infants.

关 键 词：小肠结肠炎 坏死性 早产儿 脑损伤 外科手术 危险因素 

分 类 号：R722.6[医药卫生—儿科] R726.5[医药卫生—临床医学]