【目的】 探讨早产儿消化道穿孔早期临床诊断,为早治疗提供依据。 【方法】 总结本院近5年共10例早产儿消化道穿孔的一般情况,发病时间及早期临床表现特点、诊断方法、预后,分析穿孔的可能促发因素。 【结果】 1)10例患儿,男女比例为3∶2,平均胎龄32周,平均体重1 555 g , 其中小于胎龄儿(small for gestational age,SGA)5例,双胎7/10;2)发病时间平均为生后26 h(9~70 h)。以呕吐、腹胀为首发症状,出现典型临床表现时间平均为生后48 h(18~96 h)。典型临床表现包括腹胀、张力高、腹壁发青,肠音消失。腹部立位X片显示膈下可见大量游离气体,肝界下移,部分病例腹腔穿刺。2例术后良好,7例死亡,死亡率7/9。1例失访;3)促发因素:感染继发消化道穿孔2例(2/10);自发性消化道穿孔8例(8/10),穿孔后继发感染者6例(6/8)。6例首发症状出现前按时开奶。消化道穿孔前无创呼吸机治疗共5例(5/10)。 【结论】 小胎龄、低出生体重是发生消化道穿孔高危因素;生后1~2 d、重症感染是穿孔发生的高危时间;呕吐和/或腹胀为常见的首发症状;早产儿消化道先天发育薄弱是基础,感染、喂养及无创通气可能为促发因素。出现上述情况临床警惕消化道穿孔。

【Objective】 To explore the early clinical diagnosis of gastrointestinal perforation in preterm neonates. 【Methods】 Ten cases of premature gastrointestinal perforation were registered in five years.Based on their general conditions,the incidence time,early clinical manifestation,diagnostic methods and prognosis of gastrointestinal perforation and possible precipitating factor of perforation,the early clinical diagnosis of gastrointestinal perforation in preterm neonates were analyzed. 【Results】 1)Totally,there were ten cases (6 males) with the average gestational age of 32 weeks,average body weight of 1 555 g,which included five small gestational age (SGA) perterms and 7 babies were one of the twin infants (7/10).2)Perforation occurred during 9 hours to 70 hours after birth (average=26 hours).The first clinical symptoms of the perforation were vomiting and abdominal distension;typical clinical manifestation appearance time was from 18 hours to 96 hours after birth (average=48 hours).The typical clinical manifestations included abdominal distension,high tension,abdominal wall pallidness,bowel sounds disappearence.The abdominal orthostatic X-ray images showed a great quantity of free gas under the flat diaphragm,declined liver bound,and abdominal paracentesis in some cases.Two cases were with good post-surgical outcomes and 7 cases died (mortality=7/9);1 case was lost of following-up.3)Induce factors of the gastrointestinal perforation:infection followed by gastrointestinal perforation (2/10);spontaneous gastrointestinal perforation (8/10);gastrointestinal perforation followed by infection (6/8).Six cases began to feed before onset symptoms appeared.Five cases had noninvasive ventilator before gastrointestinal perforation (5/10). 【Conclusions】 Small gestational age and low birth weight are high-risk factors of the gastrointestinal perforation.One to two days after birth and during severe infection is the high-risk occurrence time.Vomiting and/or abdominal distension are the first clinical symptoms in premature infants with perforation.Congenital poor growth in digestive tract is the foundation of perforation in premature infants.Infection,feeding and noninvasive ventilation may be precipitating factors.Once above-mentioned conditions appear in premature infants,we should be precautious about the gastrointestinal perforation in clinic.