新生儿全肠坏死型小肠结肠炎临床特点研究  

Clinical characteristics of necrotizing enterocolitis-totalis

作　　者：方文海 何秋明 钟微 赵培智 侯龙龙 邹鹏建 何娟 钟帷韬 Fang Wenhai;He Qiuming;Zhong Wei;Zhao Peizhi;Hou Longlong;Zou Pengjian;He Juan;Zhong Weitao(Department of Surgical Neonatal Intensive Care Unit,Guangzhou Women and Children's Medical Center,Guangzhou Medical University,Guangzhou 510623,China)

机构地区：[1]广州医科大学附属妇女儿童医疗中心新生儿外科监护室,广州510623

出　　处：《中华新生儿科杂志（中英文）》2024年第10期582-586,共5页Chinese Journal of Neonatology

基　　金：广州市科技计划项目-市校(院)企联合资助项目-基础与应用基础研究项目(2024A03J1171)。

摘　　要：目的探讨新生儿全肠坏死型小肠结肠炎(necrotizing enterocolitis-totalis,NEC-T)患儿的临床特点。方法回顾性分析广州医科大学附属妇女儿童医疗中心新生儿外科2015年6月至2021年12月收治的新生儿坏死性小肠结肠炎(ecrotizing enterocolitis,NEC)手术患儿的临床资料,选择术中探查存在大于75%长度小肠坏死的患儿为NEC-T组,并按照1∶2的比例随机选取同期入院且与NEC-T组胎龄匹配的非全肠坏死型小肠结肠炎(necrotizing enterocolitis-non-totalis,NEC-non-T)患儿为NEC-non-T组。比较两组患儿围产期情况、临床表现、影像学检查结果、手术及预后情况。结果共纳入78例,其中NEC-T组26例,NEC-non-T组52例。NEC-T组起病前需机械通气(80.8%比53.8%)、输血(57.7%比26.9%)、起病前合并败血症(61.5%比23.1%)比例高于NEC-non-T组,起病后呼吸暂停(50.0%比19.2%)、休克(73.1%比26.9%)、门静脉积气(88.5%比32.7%)、肠壁积气(92.3%比71.2%)比例高于NEC-non-T组,起病到手术时间(28 h比120 h)、术中探及肠穿孔(11.5%比55.8%)比例低于NEC-non-T组,再次手术(26.9%比3.8%)比例和病死率(80.8%比5.8%)高于NEC-non-T组,差异均有统计学意义(P<0.05)。结论NEC-T起病急骤,进展快速,病死率高。生后机械通气、输血、起病前合并败血症的患儿,特别是在起病后出现呼吸暂停及休克表现,且腹部X线片提示门静脉积气、肠壁积气者,需警惕NEC-T可能,应及时治疗,以降低病死率,改善预后。ObjectiveTo study the clinical characteristics of necrotizing enterocolitis-totalis(NEC-T)in neonates.MethodsFrom June 2015 to December 2021,neonates diagnosed of NEC and received surgery in Guangzhou Women and Children's Medical Center were retrospectively reviewed.They were assigned into NEC-T group and NEC-non-totalis(NEC-non-T)group according to the extent of intestinal necrosis.Perinatal conditions,clinical manifestations,imaging findings,surgery and prognosis of the two groups were compared.ResultsA total of 78 neonates were enrolled,including 26 in NEC-T group and 52 in NEC-non-T group.Before the onset of disease,the incidences of mechanical ventilation(MV)(80.8%vs.53.8%),blood transfusion(57.7%vs.26.9%)and combined sepsis(61.5%vs.23.1%)were higher in NEC-T group than NEC-non-T group.After onset,NEC-T group showed higher incidences of apnoea(50.0%vs.19.2%),shock(73.1%vs.26.9%),portal vein gas(88.5%vs.32.7%)and intestinal wall gas(92.3%vs.71.2%).NEC-T group had shorter onset-to-surgery time(28 h vs.120 h),lower incidence of intestinal perforation(11.5%vs.55.8%),higher reoperation rate(26.9%vs.3.8%)and morbidity/mortality(80.8%vs.5.8%)than NEC-non-T group(all P<0.05).ConclusionsNEC-T has an acute onset,rapid progression and high mortality.For neonates with postnatal MV,blood transfusion and sepsis,especially those with apnea and shock after the onset of illness and portal vein and intestinal wall gas on abdominal X-ray,the possibility of NEC-T should be considered.Timely treatment are needed to reduce morbidity and mortality and improve prognosis.

关 键 词：坏死性小肠结肠炎 全肠型 新生儿 

分 类 号：R722.1[医药卫生—儿科]