影响新生儿坏死性小肠结肠炎发生的危险因素及手术时机研究

Risk factors and surgical timing of necrotizing enterocolitis in neonates

目的分析影响新生儿坏死性小肠结肠炎(NEC)发生的危险因素,并探讨其手术治疗时机。方法回顾性分析2013年1月至2018年12月我院70例NEC患儿和140例非NEC新生儿临床资料,对可能影响NEC发生的因素进行单因素和多因素logistic回归分析,并统计NEC患儿治疗方法,将手术治疗患儿按照其手术时机分为早期手术组(手术年龄≤7d)和晚期手术组(7d<手术年龄≤28d),比较两组手术情况。结果NEC组妊娠期高血压疾病、产前使用糖皮质激素、胎膜早破、新生儿Apgar评分、新生儿体重、合并肺部感染、合并败血症、喂养方式与非NEC组存在差异(P<0.05)。新生儿Apgar评分<7分、新生儿体重<2.5kg、合并肺部感染、合并败血症是新生儿NEC发生的危险因素(P<0.05),母乳喂养是新生儿NEC发生的保护因素(P<0.05)。早期手术组手术指征、术后各并发症发生率和生存率与晚期手术组均无显著差异(P>0.05)。结论新生儿NEC发生的影响因素包括新生儿Apgar评分、新生儿体重、合并肺部感染、合并败血症和母乳喂养,需根据NEC患儿实际情况选择手术时机。

Objective To analyze the risk factors affecting necrotizing enterocolitis (NEC) in neonates and to explore the surgical treatment timing.Methods A retrospective analysis was performed on 70 cases of NEC children patients and 140 non-NEC neonates in our hospital from January 2013 to December 2018,and univariate analysis and multivariate logistic regression analysis were performed on factors that might affect NEC occurrence,and the treatment methods and results were counted among NECchildren patients.Results There were significant differences between NEC group and non-NEC group in terms of hypertensive disorder complicating pregnancy,prenatal glucocorticoids,premature rupture of membranes,neonatal Apgar score,neonatal weight,combined pulmonary infection,combined sepsis and feeding patterns(P<0.05).Neonatal Apgar score <7 points,neonatal weight <2.5 kg,combined pulmonary infection and combined sepsis were risk factors for NEC in neonates(P<0.05),and breastfeeding was a protective factor for NEC in neonates(P<0.05).Conclusion Influencing factors for NEC in neonates include neonatal Apgar scores,neonatal weight,combined pulmonary infection,combined sepsis and breastfeeding.Children patients with Bell stage Ⅰ and stage Ⅱ are given conservative treatment,and children patients with stage Ⅲ stage are treated with surgery as soon as possible,and the surgical timing is suitable within 1 week after the occurrence of NEC.