影响新生儿坏死性小肠结肠炎预后的危险因素

Prognosis related risk factors in neonatal necrotizing enterocolitis

目的分析与新生儿坏死性小肠结肠炎(NEC)预后不良有关的因素,为改善NEC的预后提供理论依据。方法对1995年4月至2006年4月我院收治的63例新生儿NEC患儿进行回顾性分析,根据转归不同分为治愈组和预后不良组,比较两组可能与预后相关因素的差异,寻找与预后不良有关的因素,再将单因素分析的结果代入Logistic回归方程进行多因素分析,找出与新生儿NEC预后有关的危险因素。结果63例NEC患儿中根据Bell分期,Ⅰ期38例,Ⅱ期10例,Ⅲ期15例,治愈50例,死亡10例,病死率15.9%,死亡病例均为Ⅲ期患儿,加放弃3例,Ⅲ期预后不良率86.7%。按转归不同分为治愈组50例,预后不良组13例,将两组预后有关因素进行单因素分析发现,早产、呼吸暂停、腹膜炎、休克、DIC、硬肿症、高血糖症、低钠血症、代谢性酸中毒、血小板减少、白细胞异常、腹部X线明显异常、肠穿孔两组差异有统计学意义(P<0.05),提示上述因素与新生儿NEC预后有关。把上述13个单因素进一步做多因素回归分析发现休克、代谢性酸中毒、硬肿症是与NEC预后不良关系最为密切的因素。经分析两组差异有统计学意义(P<0.05)。结论新生儿NEC并发休克、硬肿症、代谢性酸中毒是影响预后的主要危险因素;积极防治NEC的合并症,有助于降低病死率,改善预后。

Objective To explore the risk factors related to the prognosis of neonatal necrotizing enterocolitis （NEC）. Methods Sixty three NEC newborn infants who admitted to our hospital from April 1995 to April 2006 were enrolled and analyzed retrospectively. Fifty infants recovered and they were named as recovery group. The other 13 infants died or quitted therapy, and they were named as poor outcome group. Forty-one possible risk factors which responsible for prognosis of NEC were analyzed by single factor research among two groups. Above results were analyze by Logistic regression again. Results According to Bell stage, there were 38, 10 and 15 cases in stage 1,2 and 3 respectively. Stage 3 had the highest mortality rate （66.67%）. Single factor analysis showed that poor outcome group had more complications than the recovery group. The risk factors included premature, apnea, peritonitis, shock, intestinal perforation, DIC, sclerema neonatornm, hyperglycemia, hyponatremia, metabolic acidosis, abnormal leucocytes, thromboeytopenia and obviously abnormal of abdominal X-ray （P 〈 0. 05 ）. Regression analysis showed that shock, sclerema neonatornm, metabolic acidosis predicted and related with poor outcome of NEC. Conclusion Shock, sclerema neonatorum, obviously abnormal of abdominal X-ray, metabolic acidosis are high risk factors affecting the prognosis of NEC.