极早早产儿坏死性小肠结肠炎的临床特征与危险因素分析

Clinical characteristics and risk factors of necrotizing enterocolitis in very premature infants

目的分析极早早产儿坏死性小肠结肠炎(NEC)的临床特征及发病的危险因素,为极早早产儿NEC的预防提供依据。方法回顾性收集2012年1月—2019年11月郑州大学第三附属医院新生儿重症监护病房收治的胎龄<32周的极早早产NEC患儿及分层随机抽样选择同期同胎龄的非NEC患儿各113例的临床资料。分析极早早产儿NEC的临床特征和应用Logistic回归分析极早早产儿发生NEC的危险因素。结果1)病程与转归:极早早产儿NEC的发病日龄为[12.0(5.0~22.5)]d,Ⅲ期较Ⅱ期NEC患儿发病日龄更早(Z=3.05,P=0.002)、出生体重更低(t=2.46,P=0.015)、病死率更高(χ^(2)=63.65,P<0.001)。2)临床表现主要为腹胀、呼吸暂停、肉眼血便和呕吐,Ⅲ期较Ⅱ期NEC腹胀更严重(χ^(2)=5.09,P=0.024)。3)合并症:Ⅲ期NEC中重度窒息、机械通气、Ⅲ~Ⅳ级呼吸窘迫综合征(RDS)、败血症以及男婴的发生率均高于Ⅱ期NEC(χ^(2)=4.69、8.51、5.32、3.89、5.75,P<0.05或<0.01);而发病前喂养率、发病前喂养量均低于Ⅱ期NEC(χ^(2)=12.32,Z=3.93,P<0.001)。4)Logistic回归分析显示男婴(OR=1.888,95%CI:1.019~3.499,P=0.043)、败血症(OR=6.866,95%CI:3.522~13.385,P<0.001)、低钙血症(OR=2.684,95%CI:1.053~6.840,P=0.039)是极早产儿发生NEC的危险因素,纯母乳喂养(OR=0.318,95%CI:0.108~0.933,P=0.037)为保护因素。结论极早早产儿NEC的临床表现与疾病严重程度有关,临床上应加强对高危早产儿的早期识别,早期采取预防措施,降低NEC的发生率。

Objective To investigate the clinical characteristics and risk factors of necrotizing enterocolitis(NEC)in very preterm infants,in order to provide reference for preventing NEC.Methods A retrospective case-control study was performed during January 2012 to November 2019 on 113 very preterm infants with NEC and 113 infants without NEC in the neonatal intensive care unit of the Third Affiliated Hospital of Zhengzhou University.The clinical characteristics of NEC in very premature infants were investigated and the risk factors of NEC were analyzed by Logistic regression.Results 1)NEC occurred at the age of[12.0(5.0—22.5)]days old in very preterm infants.Infants with NEC stageⅢhad earlier onset age(Z=3.05,P=0.002),lower birth weight(t=2.46,P=0.015)and higher mortality(χ^(2)=63.65,P<0.001)compared with infants with NEC stageⅡ.2)The clinical manifestations of very preterm infants with NEC were mainly abdominal distention,apnea,gross blood stool and emesis.Abdominal distention in infants with NEC stageⅢwere more severe than that with NEC stageⅡ(χ^(2)=5.09,P=0.024).3)The incidence of severe asphyxia,mechanical ventilation,grade III—IV RDS,sepsis and the proportion of boys in infants with NEC stageⅢwere higher than that with NEC stageⅡ(χ^(2)=4.69,8.51,5.32,3.89,5.75,P<0.05 or 0.01).Feeding rate and feeding amount in infants with NEC stageⅢwere significantly lower compared with infants with NEC stageⅡ(χ^(2)=12.32,Z=3.93,P<0.001).4)Logistic regression analysis showed that male infants(OR=1.888,95%CI:1.019—3.499,P=0.043),sepsis(OR=6.866,95%CI:3.522—13.385,P<0.001)and hypocalcemia(OR=2.684,95%CI:1.053—6.840,P=0.039)were risk factors for NEC in very premature infants,while breastfeeding(OR=0.318,95%CI:0.108—0.933,P=0.037)was a protective factor.Conclusions The clinical manifestations of NEC in very premature infants vary with the severity of the disease.Early identification of high-risk premature infants should be strengthened in clinical practice,and preventive measures should be taken early to reduce the incidence of NEC.