先天性消化道畸形住院患儿的特点和预后影响因素的研究

Characteristics and prognostic influential factors of hospitalized infants with congenital digestive tract malformation

【目的】探讨0～3月先天性消化道畸形住院患儿的临床特征和预后影响因素,为制定其有效救治体系提供科学依据。【方法】选取湖南省儿童医院新生儿外科1年内收治的466例先天性消化道畸形患儿。采用单因素Lo-gistic回归和多因素Logistic回归统计分析其基本特征和预后影响因素。【结果】466例患儿中,男332例,占71.24%;女134例,占28.76%。农村367例,占78.76%;城市99例,占21.24%。农村较城市易发生水电解质紊乱、肺炎、腹膜炎、消化道穿孔和营养不良等并发症。治愈385例,占82.62%;好转13例,占2.79%;放弃32例,占6.87%;死亡36例,占7.73%。其中农村死亡32例,城市死亡4例,农村患儿的病死率高于城市。通过单因素Logistic回归分析,影响患儿住院转归的因素主要是:感染性休克、呼吸衰竭、败血症、DIC和硬肿症等。经多因素Logistic回归分析,影响患儿住院转归的因素主要是:呼吸衰竭、消化道穿孔、败血症和发病日龄。【结论】先天性消化道畸形的预后与感染性休克、呼吸衰竭、消化道穿孔、败血症、DIC和硬肿症等密切相关。先天性消化道畸形防治工作的重点在农村。开展产前诊断,早期诊断,普及相关知识,早期手术治疗和提高医院的救治水平可提高该病的治愈率。

[Objectivel Through researching the characteristics and prognostm influential factors ot me nosplializeu infants with congenital digestive tract malformation aged 0- 3 months, the present study aims at providing a scientific guideline for the establishment of an effective emergency rescue system for it. [Methods] Subjects were 466 hospitalized infants with congenital digestive tract malformation in the Neonatal Surgery Department of Hunan Children＇s Hospital within one year. Their basic features and influential factors on the outcome of these infants were analyzed by the approaches of single factor logistic regression analysis and multiple factor logistic regression analysis. [Results] The number of infants with congenital digestive tract malformation was 466, with 332 boys （71.24%） and 134 girls （28.76%）, and with 367 rural patients （78.76 %） and 99 urban patients （21.24 %）. The rural patients were much easier to suffer from such complications than urban patients as fluid and electrolyte imbalance, pneumonia, peritonitis, digestive tract perforation, malnutrition and so on. 385 cases of the patients were cured, accounting for 82.62%; 13 cases （2.79%） got better; 32 cases （6.87%） gave up and 36 cases （7.73%） died. And among the dead cases, there were 32 rural patients and 4 urban patients. The fatality rate of infants in rural areas was higher than that in urban areas. Through the application of single factor logistic re gression analysis, the influential factors on the outcome of hospitalized infants with congenital digestive tract malformation were infectious shock, respiratory failure, septicemia, DIC, scleredema etc. Through the application of the multiple factor logistic regression analysis, the influential factors were respiratory failure, digestive tract perforation, septicemia and onset of disease. [Conclusions] The prognosis of congenital digestive tract malformation is closely related to such factors as infectious shock, respiratory failure, digestive tract perforation, septicemia, DIC, scleredema and so on. Countryside is the emphasis of prevention and treatment of congenital digestive tract malformation. In order to elevate the recovery rate, we should carry out prenatal diagnosis and early diagnose, popularize the knowledge of diagnose digestive tract malformation in countryside, give early operations and raise the level of treatment of the hospital.