新生儿胃食管反流47例临床分析及随访研究

Clinical characteristics and follow-up study of 47 neonates with gastroesophageal reflux

目的分析新生儿胃食管反流（GER）的临床特点，比较不同反流程度患儿并发症情况及结局。方法收集2008年8月至2017年9月北京大学第一医院新生儿病房收治的经上消化道造影检查确诊GER新生儿的临床资料，记录患儿一般情况、影像学检查结果、治疗方法、治疗效果。出院后随访1年，比较不同反流程度患儿症状消失的时间。结果GER新生儿47例（男23例，女24例）；足月儿42例，早产儿5例；胎龄34～41周[（38.9±1.6）周]；出生体质量1 990～4 430 g[（3 157.3±574.0） g]；起病日龄中位数2 d（1～21 d）。以反复呕吐为表现40例（85.1%），发作性发绀7例（14.9%）。并发症：并体质量增长缓慢42例（89.4%），并吸入性肺炎24例（51.1%），并呼吸暂停1例（2.1%）。上消化道造影诊断轻度反流13例，重度反流34例。经体位喂养或联合口服多潘立酮治疗，44例患儿至出院时症状改善。出院后随访显示，轻度反流患儿症状消失时间明显早于重度反流患儿[4周（2～8周）比8周（2～40周）]，差异有统计学意义（Z＝－2.336，P〈0.05）。结论新生儿GER以呕吐为主要表现，多数预后良好。轻度反流较重度反流患儿症状消失时间早。

ObjectiveTo study the clinical characteristics of the newborns with gastroesophageal reflux （GER）, and to compare the complications and outcomes of different degrees of reflux retrospectively.MethodsNeonates diagnosed with GER by using upper gastrointestinal series admitted to neonatal ward of Peking University First Hospital from August 2008 to September 2017 were enrolled for the study.Data of demographic characteristics, radiographic imaging findings, treatment methods and efficacy of therapy of patients were collected.Infants enrolled in this study were followed up for 1 year after being discharged from hospital.The lasting time of reflux symptoms with different degrees of reflux were compared.ResultsA total of 47 cases of GER were enrolled, of whom 23 cases were male, and 24 cases were female.There were 42 term infants and 5 preterm infants.Their gestational age ranged from 34 to 41 weeks[（38.9±1.6） weeks], and birth weight was from 1 990 g to 4 430 g[（3 157.3±574.0） g]. The median onset age was 2 days, ranged from 1 to 21 days.The clinical manifestations were recurrent vomiting （40/47 cases, 85.1%） and paroxysmal cyanosis （7/47 cases, 14.9%）. Complications presented as poor weight gain （42/47 cases, 89.4%）, aspiration pneumonia （24/47 cases, 51.1%） and apnea （1/47 cases, 2.1%）. The findings of upper gastrointestinal imaging assigned the patients into 2 groups, 13 cases of mild reflux group and 34 cases of severe reflux group.After positional therapy together with domperidone, 44 patients showed improvement of symptoms.After their discharge, the lasting time of reflux symptoms in the mild reflux group was significantly shorter than in the severe group [4 weeks（2-8 weeks） vs.8 weeks （2-40 weeks）], and the difference was significant（Z=-2.336, P〈0.05）.ConclusionsNeonates with GER mainly manifest recurrent vomiting, and most of them have a favorable prognosis.The reflux symptoms last for less time in the mild reflux infants than in the severe patients.