新生儿坏死性小肠结肠炎的高危因素及外科治疗预后影响因素的研究

发布时间：2018-03-30 16:13

  本文选题：新生儿坏死性小肠结肠炎　切入点：危险因素　出处：《重庆医科大学学报》2017年03期

【摘要】：目的:探讨新生儿坏死性小肠结肠炎(neonatal necrotizing enterocolitis,NEC)的发病危险因素以及外科治疗预后的影响因素。方法:对2005年6月至2015年12月我院接收的59例新生儿NEC患儿以及80例非肠道疾病住院新生儿患者的临床资料进行回顾性分析,对影响NEC发病的危险因素进行单因素及多因素logistic回归分析;同时对59例NEC患儿根据预后情况分成2组,即存活组与死亡组,对影响NEC患儿外科治疗预后的因素进行分析。结果:NEC发病单因素分析结果显示,新生儿NEC的发病与产时窒息、产前使用糖皮质激素、感染肺炎、合并呼吸衰竭、感染性休克、弥漫性血管内凝血、发病前输注红细胞、脐静脉置管、出生后吸氧、低钙血症、低钠血症、败血症、口服益生菌、发病前喂养有关;NEC发病多因素logistic回归分析结果显示,感染肺炎、败血症、脐静脉置管是诱发NEC的高危因素(OR=2.976~5.352,P0.05),产前使用糖皮质激素、发病前喂养、益生菌是NEC的独立保护因素(OR=0.435~0.605,P0.05);外科治疗预后因素分析结果显示,NEC患儿出现循环衰竭、≥3处穿孔、感染性休克、代谢性酸中毒、低体质量,预后越差(P0.05)。结论:NEC的发病与多种因素密切相关,通过控制NEC的高危因素、增加保护因素可减少NEC的发病;影响NEC外科治疗预后的因素同样众多,如循环衰竭、≥3处穿孔、低体重儿等,对于易诱发不良预后的因素应给予积极的防治措施,以改善患儿预后,提高其存活率。
[Abstract]:Objective: to investigate the risk factors of neonatal necrotizing enterocolitis (NEC) and the prognostic factors of surgical treatment.Methods: the clinical data of 59 neonates with NEC and 80 hospitalized neonates with non-intestinal diseases from June 2005 to December 2015 were retrospectively analyzed.Univariate and multivariate logistic regression analysis was used to analyze the risk factors affecting the pathogenesis of NEC and 59 cases of NEC were divided into two groups according to their prognosis: survival group and death group. The factors influencing the prognosis of NEC patients were analyzed.Results the univariate analysis of NEC showed that neonatal NEC was asphyxiated during labor, prepartum use of glucocorticoid, infection with pneumonia, respiratory failure, septic shock, diffuse intravascular coagulation, red blood cell transfusion before onset.Umbilical vein catheterization, postnatal oxygen inhalation, hypocalcemia, hyponatremia, septicemia, oral probiotics, feeding before onset related to the incidence of NEC logistic regression analysis showed that infection pneumonia, septicemia,Umbilical vein catheterization is a high risk factor for inducing NEC. The risk factor is ORG 2.976 ~ 5.352% P0.05A, pre- partum use of glucocorticoid, feeding before onset, probiotics is the independent protective factor of NEC (Orr 0.4350.605) P0.05.The prognostic factor analysis of surgical treatment showed that there were circulatory failure and more than 3 perforations in children with NEC.Septic shock, metabolic acidosis, low body mass and worse prognosis (P 0.05).Conclusion the incidence of NEC is closely related to many factors. By controlling the high risk factors of NEC, increasing the protective factors can reduce the incidence of NEC, and there are many factors affecting the prognosis of NEC surgical treatment, such as circulatory failure, 鈮，

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