Wu Xiaoxia,Liu Wenyue,Zhang Hui,et al.Risk factors of poor short-term prognosis in neonatal intestinal atresia children[J].Journal of Clinical Pediatric Surgery,2023,22(09):818-821.[doi:10.3760/cma.j.cn101785-202306009-004]
新生儿肠闭锁术后短期预后不良危险因素分析
- Title:
- Risk factors of poor short-term prognosis in neonatal intestinal atresia children
- Keywords:
- Intestinal Atresia; Prognosis; Risk Factors; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨新生儿肠闭锁术后短期预后不良的危险因素。方法 回顾性分析山西省儿童医院2009年1月至2020年5月因肠闭锁行手术治疗的新生儿患者临床资料和随访资料。根据术后180 d是否生存分为存活组和死亡组。比较两组患儿出生体重、胎龄、性别、手术时日龄、手术时间、闭锁分型、闭锁部位、是否为复杂型肠闭锁以及术后是否并发吻合口漏、肠梗阻、坏死性小肠结肠炎(necrotizing enterocolitis,NEC)和短肠综合征等,分析可能与肠闭锁术后短期预后不良相关的因素。将单因素分析中P＜0.10的变量纳入多因素Logistic回归分析,筛选影响肠闭锁术后短期预后不良的危险因素。结果 本研究共纳入肠闭锁患儿298例,其中存活组267例,死亡组31例,治愈率为89.60%(267/298)。两组患儿性别、手术时日龄和手术时间比较,差异均无统计学意义(P＞0.05)。死亡组复杂型肠闭锁占比[70.97%(22/31)比 32.21%(86/267)],早产儿占比[54.84%(17/31)比 27.34%(73/267)],低出生体重儿占比[54.84%(17/31)比 16.48%(44/267)],术后合并NEC[22.58%(7/31)比 3.37%(9/267)]、吻合口漏[19.35%(6/31)比 1.50%(4/267)]及短肠综合征占比[25.81%(8/31)比 7.49%(20/267)]均显著高于存活组(P＜0.05)。多因素Logistic回归分析显示,术后吻合口漏(OR=41.682,95%CI:7.537~230.512)、合并NEC(OR=12.325,95%CI:2.857~53.180)、低出生体重(OR=6.614,95%CI:2.124~20.601)和复杂型肠闭锁(OR=5.149,95%CI:1.623~16.337)是新生儿肠闭锁术后短期预后不良的危险因素。结论 吻合口漏、合并NEC、低出生体重和复杂型肠闭锁可能与新生儿肠闭锁术后短期预后不良有关。
- Abstract:
- Objective To explore the risk factors of poor short-term prognosis after surgery in neonatal intestinal atresia(NIA)children.Methods From January 2009 to May 2020,the relevant clinical and follow-up data were retrospectively reviewed for 298 NIA children.They were assigned into two groups of survival(n=267)and death(n=31)according to whether or not surviving within 180 days post-operation.The factors associated with the prognosis of NIA were compared between two groups,including birth weight,gestational age,gender,operative age,operative duration,atresia type,atresia location and complex intestinal atresia,postoperative anastomotic leakage,intestinal obstruction,necrotizing enterocolitis(NEC)and short bowel syndrome(SBS).Variables with P＜0.10 in univariate analysis were included for multivariate logistic regression analysis for screening the risk factors for poor short-term prognosis of NIA.Results The curative rate was 89.60%.No significant inter-group differences existed in gender,operative age or operative duration(P>0.05).Significant inter-group differences existed in proportion of complex NIA[70.97%(22/31)vs.32.21%(86/267)],prematurity[54.84%(17/31)vs.27.34%(73/267)],low birth weight[54.84%(17/31)vs.16.48%(44/267)],postoperative necrotizing enterocolitis(NEC)[22.58%(7/31)vs.3.37%(9/267)],anastomotic leakage[19.35%(6/31)vs.1.50%(4/267)]and SBS[25.81%(8/31)vs.7.49%(20/267)](P<0.05).Logistic multivariate regression analysis indicated that postoperative anastomotic leakage(OR=41.682,95%CI:7.537-230.512),NEC(OR=12.325,95%CI:2.857-53.180),low birth weight(OR=6.614,95%CI:2.124-20.601)and complex NIA(OR=5.149,95%CI:1.623-16.337)were risk factors for poor short-term prognosis of NIA.Conclusion Anastomotic leakage,NEC,low birth weight and complex NIA are risk factors for poor short-term prognosis of NIA.
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备注/Memo
收稿日期:2023-6-4。
基金项目:山西省重点研发计划项目(201803D31181);山西省儿童医院课题(2021027);山西省卫生健康委课题(2022074)
通讯作者:任红霞,Email:renhongxia100@sina.com