新生儿坏死性小肠结肠炎并发败血症临床分析

Clinical analysis of neonatal necrotizing enterocolitis complicated septicemia

目的:了解新生儿坏死性小肠结肠炎(neonatal necrotizing enterocolitis,NEC)并发败血症的发病率、相关高危因素及病原菌。方法:对2000年7月至2013年2月在我院确诊的277例新生儿NEC患儿的临床资料进行回顾性统计,对并发败血症群体和其血/腹腔液培养结果进行分析总结。结果:我院新生儿NEC并发败血症的发病率为28.5%(79/277)。79例患儿中,平均胎龄(36.62±3.26)周,早产儿32例(40.5%),早产儿的发生率更高(P=0.049);平均出生体质量(2 551.06±737.90)g;平均发病日龄(10.30±12.18)d,早产儿平均发病日龄(12.90±16.23)d,胎龄越小,发病时间越晚;母亲围产期因素以感染性疾病史、胎膜早破及羊水异常居多;临床表现以腹胀、呕吐、少吃少哭少动和高胆红素血症为主;其他主要合并或并发症为肺炎、肠穿孔和腹膜炎;血液分析符合临床诊断标准72例(91.1%);治愈19例(24.1%),好转28例(35.4%),放弃23例(29.1%),死亡9例(11.4%)。临床分期以Ⅲ期为主(49例,62.2%)。培养结果:72份标本共分离病原菌13种38株,血培养阳性率46.9%,腹腔液培养阳性率66.7%,主要有肺炎克雷伯菌(29.1%)和大肠埃希菌(29.1%)。结论:Ⅱ期以上NEC易并发败血症,病原菌以肠杆菌科为主。确诊NEC时,应常规做血培养,重视厌氧菌培养,并定期监测实验室指标,注意监控疾病发展,以便能切断或减少肠源性败血症发生的机会。

Objective： To study the incidence, risk factors and pathogens of neonatal necrotizing enterocolitis （NEC） complicated sep- ticemia. Methods ： Clinical features were analyzed retrospectively in 277 newborns suffering from NEC. Pathogens results of blood and peritoneal fluid culture samples were analyzed in infants with NEC complicated septicemia,who were medically treated in the Chil- dren＇s Hospital of Chongqing Medical University from July 2000 to February 2013. Results：Incidence of NEC complicated septicemia was 28.5%（79/277）, higher in preterm group（P=0.049）. Among 79 neonates, there were 32 preterm infants（40.5%）. Average gesta- tional age and birth weight were （36.62 ± 3.26） weeks and （2 551.06 ± 737.90） grams,respectively. Average day of onset was （ 10.30 ± 12.18） d, of which the preterm group was （12.90 4± 16.23） d;the smaller the gestational age,the later the onset time. Main prenatal factors were infectious diseases, premature rupture of membranes and amniotic fluid abnormalities. Chief clinical manifestations were abdominal distension, vomiting, apathetic and hyperbilirubinemia. The other accompaniments or complications were pneumonia, in- testinal perforation and peritonitis. Seventy two cases （91.1%） met the clinical diagnostic criteria in blood analysis. Finally, 19 infants （24.1%） were cured, 28 infants （35.4%） were improved, while 9 infants （ 11.4%） given up and 23 infants （29.1% ） died. Most infants belonged to stage 111 （49 cases,62.2%）. Out of 72 blood and peritoneal samples： 13 kinds, 38 stains were detected. Positive rates of blood and peritoneal culture were 46.9% and 66.7%,respectively. Escherichia coli（29.1%） and Klebsiellapneumoniae（29.1%） were the most common pathogens. Conclusions：Infants with NEC（stage 1I or 111 ） are prone to complicate with septicemia. Once definite diagnosis of NEC has been made, blood cultures should be routinely done. Anaerobic cultures should be emphasized on and labora- torial index should be monitored regularly so as to reduce the possibility of occurrence of gut-derived septicemia.