新生儿胃肠道穿孔临床分析及病原学研究

发布时间：2018-10-19 07:09

【摘要】：目的分析总结新生儿胃肠道穿孔的临床特征及病原学,指导临床诊疗。方法总结并分析95例患儿病例的一般资料、症状、体征、穿孔情况、病因、病原学检查、治疗及预后。结果(1)95例新生儿胃肠道穿孔主要临床表现为腹胀(85例,89.47%)及呕吐(55例,57.89%),体温异常31例(32.63%),体征以腹部膨隆(85例,89.47%)、腹壁发红(52例,54.74%)、腹壁静脉怒张(44例,46.32%)为最常见;(2)术中穿孔部位得到了证实并明确,穿孔部位位于小肠(45例,47.37%)、结肠(40例,42.11%)、胃(10例,10.53%),小肠穿孔中最常见的部位为回肠(33例,73.33%),结肠穿孔中最常见的是横结肠(11例,27.50%);(3)95例患儿中有61例在手术中取得腹腔渗液送细菌培养,46例培养阳性,共培养出53株病原菌,G-性菌40株(75.47%),其中肺炎克雷伯菌肺炎亚种(15株,37.5%)检测出最多,其次为大肠埃希氏菌(12株,30%);G+性菌13株,分别为屎肠球菌7株(53.85%)、表皮葡萄球菌3株(23.08%)、粪肠球菌2株(15.38%);(4)术中综合分析患儿全身情况、穿孔部位,以挽救患儿生命为最终目的,采取简单有效手术方式,最常见的术式为肠造瘘术,临床治愈率为82%,预后较好。(4)术中综合分析患儿全身情况、穿孔部位,以挽救患儿生命为最终目的,采取简单有效手术方式,最常见的术式为肠造瘘术,临床治愈率为82%,预后较好。结论新生儿胃肠道穿孔临床表现不典型,不明原因的腹胀伴有呕吐、发热等表现,结合腹部查体应警惕消化道穿孔的可能,通过腹部摄片发现气腹确诊;术中取腹腔渗液做检测,检测出最多的病原菌为革兰阴性菌,其中肺炎克雷伯菌肺炎亚种、大肠埃希氏菌菌最为常见,可选用半合成青霉素+第三代头孢类+硝基咪唑类抗生素抗感染,必要时根据临床症状、炎症指标、药敏结果调整抗生素类型。
[Abstract]:Objective to analyze the clinical features and etiology of gastrointestinal perforation in neonates. Methods the general data, symptoms, signs, perforation, etiology, treatment and prognosis of 95 cases were summarized and analyzed. Results (1) the main clinical manifestations of 95 neonates with gastrointestinal perforation were abdominal distension (85 cases, 89.47%), vomiting (55 cases, 57.89%), abnormal body temperature in 31 cases (32.63%), abdominal bulge (85 cases, 89.47%), redness of abdominal wall (52 cases, 54.74%), abdominal vein irritation (44 cases, 46.32%). The location of the perforation was confirmed and identified, Perforation was located in the small intestine (45 cases, 47.37%), colon (40 cases, 42.11%), stomach (10 cases, 10.53%), ileum (33 cases, 73.33%) and transverse colon (11 cases, 27.50%); (3). The bacteria were cultured in 46 positive cases. Among the 53 strains of pathogenic bacteria, 40 strains (75.47%) were G- sex bacteria. Among them, Klebsiella pneumoniae pneumonia subspecies (15 strains, 37.5%) were detected most, followed by Escherichia coli (12 strains) and 30%); G (13 strains). There were 7 strains of Enterococcus faecium (53.85%), 3 strains of Staphylococcus epidermidis (23.08%), 2 strains of Enterococcus faecalis (15.38%); (4). The most common operation was enterostomy, the clinical cure rate was 82%, and the prognosis was good. (4) the whole body condition and perforation site of the children were analyzed comprehensively during the operation, with the aim of saving children's lives as the ultimate goal, a simple and effective operation was adopted. The most common operation is enterostomy, the clinical cure rate is 82%, and the prognosis is good. Conclusion the clinical manifestations of gastrointestinal perforation in neonates are atypical, abdominal distension with unknown causes accompanied with vomiting, fever and so on. Combined with abdominal examination, the possibility of gastrointestinal perforation should be alert, and pneumoperitoneum can be found by abdominal radiography. The most common pathogens were Gram-negative bacteria, among which Klebsiella pneumoniae and Escherichia coli were the most common. The third generation of semi-synthetic penicillin nitroimidazole antibiotics can be used to resist infection, and to adjust the types of antibiotics according to clinical symptoms, inflammatory indexes and drug sensitivity results.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R722.1

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