目的 观察小于胎龄儿(SGA)与适于胎龄儿(AGA)合并坏死性小肠结肠炎(NEC)临床特点的差异,以期为NEC的预防提供依据。方法 选取2014年1月1日-2018年12月31日新生儿科收治的确诊NEC患儿(包括Ⅱ期和Ⅲ期)236例为研究对象,其中SGA组55例,AGA组181例,比较两组患儿临床特征的差异。结果 1)SGA组剖宫产出生者比例(83.6%)高于AGA组(59.7%),其母孕期合并妊娠期高血压疾病(56.4% vs.24.9%)、胎儿宫内窘迫的比例(32.7% vs. 11.6%)高于AGA组,两组间差异有统计学意义(P<0.05)。2)SGA组发生Ⅲ期NEC的比例(41.8% vs.26.5%)、预后不良(放弃+死亡)率(25.5% vs.13.3%)、住院天数[25(16,23)vs.17(12,24)]均高于AGA组,两组间差异有统计学意义(P<0.05)。两组患儿在开奶日龄、发病日龄、发病前72 h内输注红细胞、发病时WBC、CRP、PLT水平、病原学检查(大便培养、血培养)阳性率、手术治疗例数方面差异有统计学意义。3)Ⅲ期NEC、NEC诊断后主要并发症如败血症、呼吸衰竭、心力衰竭、DIC、休克、腹膜炎、肠穿孔、硬肿症、多脏器功能衰竭均是导致SGA组和AGA组预后不良的危险因素。 Logistic回归分析发现影响SGA组NEC预后不良的危险因素为Ⅲ期NEC(OR=15.211,95%CI:2.998~26.107)、NEC诊断后并发败血症(OR=10.440,95%CI:1.627~19.377)、休克(OR=12.256,95%CI:2.896~21.058)和肠穿孔(OR=6.305,95%CI:1.473~8.240);影响AGA组NEC预后不良的危险因素为Ⅲ期NEC(OR=13.352,95%CI:1.866~18.540)、NEC诊断后并发败血症(OR=9.662,95%CI:2.508~16.004)和休克(OR=11.254,95%CI:2.183~17.005)。结论 SGA并发NEC时病情较AGA更重,预后不良率更高,应积极治疗NEC后的各种并发症,从而降低死亡率。
Abstract
Objective To observe the difference on clinical characteristics between small for gestational age(SGA) and appropriate for gestational age(AGA) infants with necrotizing enterocolitis(NEC),so as to provide evidence for the prevention of NEC. Methods A total of 236 cases with NEC(stage Ⅱand Ⅲ) hospitalized from January 1st,2014 to December 31th,2018 were enrolled in this study,and were divided into SGA group(55 cases) and AGA group(181 cases).The differences on clinical characteristics between the two groups were analyzed. Results 1) The proportions of cesarean section(83.6%vs.59.7%),maternal hypertention during pregnancy(56.4% vs.24.9%) and fetal distress(32.7% vs.11.6%)in SGA group were significantly higher than those in AGA group(P＜0.05).2) The proportions of clinical stage Ⅲ(41.8% vs.26.5%) and poor prognosis(abandonment and death)(25.5% vs.13.3%) of AGA were significantly higher than those of AGA,and the hospitalization duration[25(16,23) vs.17(12,24)] of SGA was significantly longer than that of AGA(P<0.05).There were no significant differences on the age of start feeding,the onset of NEC,the ratio of RBC transfusion within 72 hours before the onset of NEC,the levels of WBC,CRP and PLT,the positive rate of etiological examination(stool culture and blood culture) and the number of cases of surgical treatment between SGA and AGA groups(P＞0.05).Logistic regression analysis showed that the risk factors for the poor prognosis of SGA included clinical stage Ⅲ of NEC(OR=15.211,95%CI:2.998-26.107),sepsis after diagnosis of NEC(OR=10.440,95%CI:1.627-19.377),shock(OR=12.256,95%CI:2.896-21.058) and intestinal perforation(OR=6.305,95%CI:1.473-8.240).Meanwhile,risk factors for the poor prognosis of AGA were clinical stage Ⅲof NEC(OR=13.352,95%CI:1.866-18.540),sepsis after diagnosis of NEC(OR=9.662,95%CI:2.508-16.004) and shock(OR=11.254,95%CI:2.183-17.005). Conclusions NEC in SGA infants is more serious than that in AGA,and the prognosis is poorer in SGA infants.Thus,complications after NEC should be treated actively in order to reduce the mortality.
关键词
小于胎龄儿 /
适于胎龄儿 /
坏死性小肠结肠炎
Key words
small for gestational age /
appropriate for gestational age /
necrotizing enterocolitis
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基金
2017年河南省科技厅重大科技专项(171100310200)
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