新生儿消化道大出血41例临床分析

Clinical review and analysis of 41 cases on neonatal massive hemorrhage of gastrointestinal tract

目的了解新生儿消化道大出血的原因、临床表现，探讨救治方法。方法对41例新生儿消化道大出血进行临床回顾性分析，总结出血原因及治疗要点。结果41例新生儿消化道大出血原因：新生儿出血症2例（4．9％），坏死性小肠结肠炎（NEC）4例（9．7％）．应激性溃疡35例（85．4％）。应激性溃疡的原因有围生期缺氧、早产、感染、早产儿肺透明膜病、硬肿症、使用激素等。消化道出血量占全身血容量的1／5～1，其中50ml～有28例，100ml-有6例，150ml-有4例，200～260ml 3例。均合并有低血容量休克，其中轻度休克30例，中度休克8例，重度休克3例。本组新生儿消化道大出血治愈率83％，病死率7．3％。结论应激性溃疡是新生儿消化道大出血的最常见原因，且为新生儿危重症的合并症。新生儿消化道大出血若原发病可恢复，预后尚好。

Objective To explore the reasons of neonatal massive hemorrhage of gastrointestinal tract, clinical manifestation and the investigate remedy method. Methods The forty-one neonatal massive hemorrhage of gastrointestinal tract was clinically reviewed and analyzed：The causes of hemorrhage and the highlight of therapy were summarized. Results The causes of 41 neonatal massive hemorrhage, of gastrointestinal tract; There were, 2 cases （4.9 % ） with hemorrhagic disease of newborn, 4 cases （9.7 % ） with necrotizing enterocolitis （NEC）, 35 cases （85.4 % ） with stress ulcer. The causes of stress ulcer were perinatal hypoxia, premature labor, infection, premature hyaline membrane disease, scleredema, using glucocorticoid or other medicine. The volume of alimentary tract hemorrhage took 1/5-1 volume of blood all over the body.Among it,28 cases were with 50ml-, 6 cases with 100ml-, 4 cases with 150ml- ,3 cases with 200-260ml. All of cases were with hypovolemic shock. Among them ,there were 30 cases with slight shock,8 eases with midrange shock and 3 cases with severity shock. The rate of cure was 83% and case fatahty was 7.3 % in this group. Conclusions Stress ulcer is the most common .cause of neonatal massive hemorrhage of gastrointestinal tract. Moreover, it is ＇also the complication of neonatal severe case. If protopathy of neonatal massive hemorrhage of gastrointestinal tractcan be recovered,the prognosis will be fine.