低出生体重新生儿坏死性小肠结肠炎手术与保守治疗效果比较

Comparison of therapeutic effects between surgery and conservative treatment on necrotizing enterocolitis in low birth weight neonates

目的观察低出生体重儿坏死性小肠结肠炎（NEC）的手术效果及预后。方法选取2013年5月至2015年3月接受治疗的100例低出生体重儿为研究对象,其中手术治疗50例（手术组）,内科保守治疗50例（非手术组）,比较经过治疗后2组患儿实验室相关指标及炎性因子水平的变化及生存率的差异,分析影响预后的危险因素。结果治疗前,2组患者实验室各项指标（大便潜血试验、血小板计数、白细胞计数等）差异无统计学意义（P〉0.05）,治疗后,手术组上述指标的改善情况均好于非手术组;治疗前2组患者炎性因子（IL-1β、TNF-α、IL-6、IL-10）水平无明显差异,治疗后,2组患者炎性因子水平均较治疗前下降,但手术组患者较非手术组下降更为明显（P〈0.05）;手术组患儿的病死率较非手术组低,预后情况明显好于非手术组;Logist回归分析法显示患儿是否合并呼吸衰竭、肾功能损害、肠穿孔或腹膜炎、WBC〈5×10~9/L或〉20×10~9/L、血小板减少和肠鸣音减弱或消失是影响其预后的重要因素。结论对合并NEC的低出生体重儿采取手术治疗可有效改善肠道功能和血常规相关指标,降低机体炎性因子水平,进而提高患儿的存活率;同时,有合并症的患儿预后往往较差,提示此类患儿应及早选择手术治疗。

Objective To compare the therapeutic effects between surgery and conservative treatment on necrotizing enterocolitis in low birth weight neonates. Methods One hundred low birth weight neonates with necrotizing enterocolitis who were admitted and treated in our hospital from May 2013 to May 2015 were enrolled in the study. The neonates were divided into two groups： surgery treatment group （ n = 50） and conservative treatment group （ n = 50）. After treatment the clinical parameters, inflammatory factors levels and survival rates were compared between two groups, moreover, the risk factors of affecting patient＇ s prognosis were analyzed. Results Before treatments, there were no significant differences in the clinical parameters including fecal occult blood test, platelet count, white blood cell count between two groups （ P 〉 O. 05 ）. After treatment,the improvement status of these parameters mentioned above in surgery treatment group was superior to that in conservative treatment group （ P 〈 O. 05 ）. Before treatments, there were no significant differences in the levels of inflammatory factors including IL-113, TNF-c~, IL-6, IL-10 between two groups （ P 〉 0.05）, however, after treatment of the levels of the inflammatory factors were significantly decreased in both groups, moreover, the decrease degree in surgery treatment group was more obvious than that in conservative treatment group （ P 〈 0.05 ）. The death rate in surgery treatment group was lower than that in conservative treatment group, and patient ＇ s prognosis in surgery treatment group was much better than that in conservative treatment group. Logist regression analysis showed that the important factors of affecting patient＇ s prognosis were respiratory failure, renal dysfunction, intestinal perforation or peritonitis, WBC 〈 5 x 109/L or 〉 20 x 109/L, thrombocytopenia and diminished or disappeared bowel sounds. Conclusion Taking surgery treatment for low birth weight neonates with necrotizing enterocolitis can effectively improve intestinal tract function and related blood routine parameters, decrease the levels of irrtlammatory factors so us to enhance survival rate of neonates. Moreover the neonates with complications may have poor prognosis, which suggests that these neonates should be treated by surgery as early as possible.