Zhao Xuwen,Hu Bo,Dai Chunjuan,et al.Risk factors of intestinal perforation in neonatal necrotizing enterocolitis[J].Journal of Clinical Pediatric Surgery,2021,20(11):1042-1047.[doi:10.12260/lcxewkzz.2021.11.009]
新生儿坏死性小肠结肠炎伴发肠穿孔的危险因素研究
- Title:
- Risk factors of intestinal perforation in neonatal necrotizing enterocolitis
- Keywords:
- Necrotizing Enterocolitis; Intestinal Perforation; Risk Factors; Infant; Newborn
- 分类号:
- R574.5;R726.566.22;R722
- 摘要:
- 目的 探讨新生儿坏死性小肠结肠炎（necrotizing enterocolitis，NEC）伴发肠穿孔的危险因素，为临床诊治提供参考。方法 收集天津市儿童医院2016年9月至2019年12月确诊为NEC伴发肠穿孔且符合纳入标准的32例患者，作为病例组；选取同期收治的NEC未伴发肠穿孔患者96例，作为对照组。对比分析两组患者的一般资料（胎龄、出生体重、性别、起病日龄、起病至肠穿孔病程）、围产期资料（母亲孕龄、宫内窘迫、胎膜早破、分娩方式、孕期合并糖尿病情况、妊娠高血压情况、孕期感染情况）、NEC诊断后并发症（呼吸衰竭、休克、败血症、凝血功能障碍、低钙血症、肝肾功能损害、低钾和高钾血症）、起病时化验结果（白细胞、血小板、血红蛋白、PCT、CRP及血清白蛋白）等临床资料，采用单因素分析和多因素Logistic回归分析，总结NEC伴发肠穿孔的危险因素。结果 单因素分析结果显示：NEC是否伴发肠穿孔与出生体重、胎龄、母亲孕龄、孕期感染、呼吸衰竭、休克、败血症、凝血功能障碍、肾功能损害、低钙血症、低钾血症、白细胞、血小板、血红蛋白、PCT、CRP及血清白蛋白水平相关（P<0.05）。多因素Logistic回归分析结果显示，凝血功能障碍（OR=7.125，95%CI：2.095~24.230）、低钾血症（OR=6.627，95%CI：1.557~28.205）是NEC伴发肠穿孔的独立危险因素，而高血清白蛋白（OR=0.792，95%CI：0.694~0.905）及白细胞数偏高（OR=0.917，95%CI：0.844~0.995）是其保护因素。结论 凝血功能障碍、低钾血症、低白细胞数及低血清白蛋白是NEC伴发肠穿孔的独立危险因素。对于新生儿NEC，临床上应早期识别其危险因素，并及时干预，以避免肠穿孔。
- Abstract:
- Objective To explore the risk factors of intestinal perforation in neonatal necrotizing enterocolitis (NEC) and provide references for its clinical diagnosis and treatments. Methods From September 2016 to December 2019, 32 children of NEC with intestinal perforation fulfilling the inclusion criteria were enrolled and 96 controls admitted simultaneously without intestinal perforation selected as control group. General data (gestational age, birth weight, gender, onset age of NEC, NEC onset to intestinal perforation) and perinatal data (maternal gestational age & uterine age) were collected retrospectively. Internal distress, premature rupture of membranes, mode of delivery, pregnancy with diabetes, pregnancy-induced hypertension & pregnancy infection), complications after NEC diagnosis (respiratory failure, shock, sepsis, coagulation dysfunction, hypocalcemia, damage of liver & kidney function, hypokalemia & hyperkalemia) and testing results at NEC onset (leukocytes, platelets, hemoglobin, PCT, CRP & albumin) were collected. Both single and multiple factor Logistic regression analyses were performed for summarizing the risk factors of intestinal perforation in NEC. Results Single factor analysis revealed significant differences between NEC with intestinal perforation and birth weight, gestational age, maternal gestational age, infection during pregnancy, respiratory failure, shock, septicemia, coagulation dysfuncton, impaired renal function, hypocalcemia, hypokalemia, leukocyte, platelet, hemoglobin, PCT, CRP and albumin (P<0.05). Multivariate logistic regression analysis indicated that coagulation dysfunction (OR=7.125, 95%CI:2.095-24.230) and hypokalemia (OR=6.627, 95%CI:1.557-28.205) were independent risk factors of intestinal perforation in NEC while high albumin (OR=0.792, 95%CI:0.694-0.905) and leukocyte count (OR=0.917, 95%CI:0.844-0.995) were protective factors. Conclusion Coagulation dysfunction, hypokalemia, low leukocyte count and low albumin are independent risk factors of intestinal perforation in NEC. Early identification of risk factors and timely intervention should be performed for preventing intestinal perforation of neonatal NEC.
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备注/Memo
收稿日期:2020-05-01。
基金项目:天津市卫生健康科技项目（编号：RC20020）；天津市儿童医院发展基金计划项目（编号：Y2020006）
通讯作者:胡博,Email:surgeonhubo@163.com