不同胎龄新生儿血便临床特征及病因分析  

Clinical Features and Etiological Analysis of Hematochezia in Newborns at Different Gestational Ages

作　　者：班晓蕊 徐发林[1] BAN Xiaorui;XU Falin(Department of Neonatology,The Third Affiliated Hospital of Zhengzhou University,Zhengzhou Henan 457000,China)

机构地区：[1]郑州大学第三附属医院新生儿科,河南郑州457000

出　　处：《临床研究》2025年第1期1-5,共5页Clinical Research

摘　　要：目的分析不同胎龄组的新生儿血便患儿临床特征及病因构成,并以新生儿坏死性小肠结肠炎及新生儿牛奶蛋白过敏为例对比分析两者临床特征。方法收集郑州大学第三附属医院新生儿病房2021年1月至2022年12月住院期间发生新生儿血便的患儿临床资料,按出生胎龄分为极早产儿组(28~31^(+6)周)、中期早产儿组(32~33^(+6)周)、晚期早产儿组(34~36^(+6)周)、足月儿组(≥37周),回顾性分析其临床特征、病因构成。结果胎龄越小新生儿血便发生时间越晚,差异具有统计学意义(P<0.001);病因分布为新生儿坏死性小肠结肠炎导致148例(59.68%),新生儿牛奶蛋白过敏52例(20.97%),新生儿阑尾炎10例(4.03%),乳糖不耐受9例(3.63%),急性胃黏膜病变7例(2.82%),中毒性肠麻痹5例(2.02%),凝血功能异常4例(1.61%),新生儿出血症3例(1.21%),新生儿红细胞增多症3例(1.21%),病毒性肠炎3例(1.21%),药物相关性2例(0.81%),血小板减少症1例(0.40%),易栓症1例(0.40%);新生儿坏死性小肠结肠炎组患儿较新生儿牛奶蛋白过敏组发病早,两者均可出现血便、呕吐、腹胀、拒奶症状,新生儿坏死性小肠结肠炎多伴有血中性细胞比例升高、粪便出现白细胞、肠壁积气或门脉积气、腹水,差异均有统计学意义(P<0.05)。结论新生儿血便在早产儿组发生率更高、但发生时间相对更晚。新生儿血便发生的病因有很多种,不论是早产儿组还是足月儿组,新生儿坏性小肠结肠炎与新生儿牛奶蛋白过敏均为较常见病因。虽然两者早期临床鉴别有一定困难,但通过本研究可发现两者存在一定差异,有助于早期明确病因,及时给予准确、规范的治疗。Objective To analyze the clinical characteristics and etiological composition of hematochezia in newborns across different gestational age groups,and to compare and analyze the clinical features of necrotizing enterocolitis and cow's milk protein allergy in newborns.Methods Clinical data of newborns with hematochezia admitted to the neonatal ward of The Third Affiliated Hospital of Zhengzhou University from January 2021 to December 2022 were collected.The newborns were categorized by gestational age into the extremely preterm group(28~31^(+6) weeks),mid-preterm group(32~33^(+6) weeks),late-preterm group(34~36^(+6) weeks),and term group(≥37 weeks).A retrospective analysis of their clinical features and etiological composition was conducted.Results The occurrence of hematochezia was delayed in newborns with smaller gestational ages,with statistically significant differences(P<0.001).The distribution of causes included necrotizing enterocolitis in 148 cases(59.68%),cow's milk protein allergy in 52 cases(20.97%),appendicitis in 10 cases(4.03%),lactose intolerance in 9 cases(3.63%),acute gastric mucosal lesions in 7 cases(2.82%),toxic intestinal paralysis in 5 cases(2.02%),coagulopathy in 4 cases(1.61%),neonatal hemorrhagic disease in 3 cases(1.21%),polycythemia in 3 cases(1.21%),viral enteritis in 3 cases(1.21%),drug-related issues in 2 cases(0.81%),thrombocytopenia in 1 case(0.40%),and hypercoagulability in 1 case(0.40%).The incidence of neonatal necrotizing enterocolitis group is earlier than that of neonatal milk protein allergy group.Both conditions presented with symptoms of hematochezia,vomiting,abdominal distension,and refusal to feed;however,necrotizing enterocolitis was more frequently associated with elevated neutrophil ratios,the presence of leukocytes in stools,intestinal wall gas or portal vein gas,and abdominal fluid accumulation,with statistically significant differences(P<0.05).Conclusion Hematochezia occurs more frequently in preterm infants but tends to appear later.There are numerous causes for h

关 键 词：胎龄 新生儿血便 新生儿坏死性小肠结肠炎 新生儿牛奶蛋白过敏 

分 类 号：R722.1[医药卫生—儿科]