Lin Tulian,Wu Qiang,Peng Yanfen,et al.Risk factors of high-output stoma after enterostomy in necrotizing enterocolitis[J].Journal of Clinical Pediatric Surgery,2022,21(04):310-314.[doi:10.3760/cma.j.cn101785-202201058-003]
新生儿坏死性小肠结肠炎肠造瘘术后造口高流量腹泻的相关因素分析
- Title:
- Risk factors of high-output stoma after enterostomy in necrotizing enterocolitis
- Keywords:
- Enterocolitis; Necrotizing/SU; Enterostomy; Diarrhea; Postoperative Complications; Risk Factors; Infant; Newborn
- 摘要:
- 目的探讨新生儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)小肠造瘘术后造口高流量腹泻(high-output stoma,HOS)的相关因素。方法以2017年7月1日至2021年6月30日广州市妇女儿童医疗中心新生儿外科监护室收治的NEC小肠造瘘术后患儿为研究对象,根据造瘘术后是否出现HOS分为腹泻组及非腹泻组。收集并比较两组患儿一般资料、手术及预后情况,采用单因素分析及多因素Logistic回归分析NEC患儿小肠造瘘术后发生HOS的相关因素。结果76例NEC患儿中,有25例(32.9%)发生HOS。单因素分析结果显示:出生体重、出生胎龄、手术时矫正胎龄及体重、术前需呼吸支持、分期与分型以及造瘘近端小肠剩余长度是NEC患儿肠造瘘术后发生HOS的相关因素(P＜0.05)。Logistic回归分析结果显示:造瘘近端小肠剩余长度(OR=1.220,95%CI:1.108~1.343)是NEC患儿术后发生HOS的独立相关因素(P＜0.05)。经造瘘近端小肠剩余长度绘制ROC曲线,曲线下面积为0.926(95%CI:0.849~1.000,P＜0.05),灵敏度为92%,特异度为74%;近端剩余小肠长度为86.5 cm时,预测NEC小肠造瘘术后发生HOS的灵敏度为84%,特异度为96%,提示造瘘近端小肠剩余长度对NEC小肠造瘘术后造口HOS的发生有较好的预测意义。结论NEC小肠造瘘术后容易发生造口HOS,近端小肠剩余肠管长度是发生造口HOS的独立危险因素,该指标对造口HOS的发生具有良好的预测意义。
- Abstract:
- ObjectiveTo explore the risk factors of high-output stoma(HOS)after enterostomy in infants with necrotizing enterocolitis(NEC).MethodsFrom July 1,2017 to June 30,2021,76 neonates undergoing enterostomy due to NEC were retrospectively reviewed.They were divided into two groups of HOS(n=25)and non-HOS(n=51)according to whether or not HOS occurred after enterostomy.General demographics,intraoperative findings and prognosis of two groups were compared.Univariate and multivariate Logistic regressions were utilized for examining the risk factors of HOS after enterostomy.ResultsUnivariate analysis indicated that birth weight,gestational age,preoperative need for respiratory support,NEC stages and subtypes,corrected gestational age,operative weight and residual length of proximal enterostomy were the relevant occurring factors for postoperative HOS(P＜0.05).Logistic regression analysis showed that residual length of proximal enterostomy was an independent risk factor of HOS after enterostomy in NEC infants(OR=1.220,95%CI:1.108-1.343,P＜0.05).Receiver operating characteristic(ROC)curve was plotted with residual length of proximal enterostomy.Area under the curve was 0.926(95%CI:0.849~1.000,P＜0.05)while the sensitivity and specificity were 92% and 74%.When residual length of proximal enterostomy was 86.5 cm,the sensitivity and specificity were 84% and 96% of HOS,indicating that it was an excellent predictor for HOS in NEC infants.ConclusionHOS is prone to occur after enterostomy in NEC infants and residual length of proximal enterostomy is an independent risk factor and an excellent predictor for HOS in NEC infants after enterostomy.
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备注/Memo
收稿日期:2022-01-29
通讯作者:钟微,Email:zhongwei@gwcmc.org