早产儿输血相关性坏死性小肠结肠炎临床特点分析

Clinical analysis of transfusion associated necrotizing enterocolitis in premature infants

目的回顾性分析早产儿坏死性小肠结肠炎（Necrotizing Enterocolitis,NEC）的临床资料,探讨TA-NEC（Transfusion Associated Necrotizing Enterocolitis,TA-NEC）的临床特点及转归。方法对自2013年1月至2017年6月本院收治的早产儿NEC进行回顾性分析。分为TA-NEC组（NEC发病前48 h内有输血史）和非输血相关NEC组（NEC发病前48h内无输血史）,从临床特点、输血因素等进行比较分析,并对比两组的临床结局和预后。结果研究期间共收治2 775名早产儿,共有46例（1. 66%）发生了NEC,其中12例为TA-NEC,占总NEC的26%（12/46）。TA-NEC组胎龄、出生体重较非输血相关NEC组要低,而发病日龄更晚,差别显著[胎龄（29. 26±0. 38）/（31. 55±0. 42）周],出生体重[（1 200±58. 17）/（1 513. 24±86. 78） g],发病日龄[（28. 67±6. 65）/（17. 03±9. 90） d]。TA-NEC组发病前血红蛋白、红细胞比容更低[（93. 83±6. 81） g/（119. 18±27. 39） g;（28. 69±3. 59）%/（34. 72±7. 39）%,P〈0. 05）]。TA-NEC组发病前均相对稳定,无机械通气、全部达到完全肠内喂养。两组患儿母亲年龄及孕期合并疾病、窒息史、宫内生长发育受限、性别及生产方式、动脉导管未闭、布洛芬应用、败血症、支气管肺发育不良、视网膜病、脑室内出血等没有统计学差异。两组间输注红细胞类型、次数、储存时间、是否来自同一供体及是否辐照没有显著差异。两组间临床表现、转归及预后无显著差异。结论与非输血相关NEC相比,早产儿TA-NEC胎龄更不成熟,出生体重更低,发病日龄偏晚,发病前贫血程度重。但贫血、输血与NEC独立相关性及与其他危险因素的相互关系尚需要进一步研究。

Objective To investigate the clinical features and prognosis of TA-NEC （Transfusion Associated Necrotizing Enterocolitis, TA-NEC） in premature infants. The clinical data of Necrotizing Enterocolitis （NEC） in premature infants were retrospectively analyzed. Methods The Clinical data of the premature infants with NEC recorded from January 2013 to June 2017 was retrospective analyzed. Patients with NEC were divided into two groups： The TA-NEC group （patients with a prior history of blood transfusion within 48 hours of onset of NEC） and The non-TA- NEC group （ patients without transfusion histo- ry within 48 hours of onset of NEC ）. Clinical characteristics , blood transfusion factors were compared between the two groups, along with clinical outcomes and prognosis of the two groups . Results Among the total investigated 2 775 premature infants during the study period, 46 cases （1.66%） were diagnosed with NEC. The average birth weight was 1 431.52±476. 03 g and average gestational age was （30. 96：t：2.45） weeks. The rate of surgery and mortality was 34. 78% and 19.56%. There were 12 cases of TA-NEC accounting for 26% of the 46 cases of NEC （12/46）. The gestational age（GA） and birth weight （BW） of TA-NEC were significantly lower than the non-TA-NEC group [ （ GA 29. 26±0. 38）/（ 31.55 ± 0.42）w, BW （ 1 200± 58.17）/（ 1 513.24±86. 78） g]. While the infant age was older in the TA-NEC group compared to the non-TA-NEC group [ （ 28. 67±6. 65）/（ 17. 03±9. 90） d]. The Hemoglobin and hematocrit of the TA-NEC group before symptom occurrence was lower than that of the non-TA-NEC group[ （93.83±6. 81 ） g vs （ 119. 18±27.39） g; （28.69±3.59）% vs （34. 72±7.39）%; P〈0. 05 ]. Conditions were relatively stable in the TA-NEC group post NEC, who were completely enteral fed with no me- chanical ventilation. There were no significant differences in gestational age, history of asphyxia, intrauterine growth restric- tion, maternal age and complications during pregnancy, sex and mode of production, patent ductus arteriosus, septicemia, bronchopulmonary dysplasia, retinopathy and intraventricular hemorrhage between the two groups. Comparation between the two groups also showed no significant differences in red blood type, number of transfusion times, storage time of the blood , whether from the same donor and whether irradiation before transfusion .There were no significant differences in clinical mani- festation and prognosis between the two groups. Conclusion Compared with the non-TA-NEC group, the TA-NEC group more often suffered from smaller gestational age and lower birth weight. TA-NEC symptoms occurred later with lower hemoglobin and hematocrit compared to the non-TA-NEC group. However, the independent associations between anemia/blood transfusion and NEC still need further investigation.