胎粪性腹膜炎的临床特征及预后相关因素分析

Analysis of clinical features and prognostic factors of meconium peritonitis

目的·研究胎粪性腹膜炎的临床特征及影响其预后的相关因素。方法·回顾性纳入2006年5月-2018年5月于上海交通大学医学院附属新华医院儿童急重症医学科接受手术干预的54例胎粪性腹膜炎患儿,将其分为并发症组(n=24)和无并发症组(n=30)。分析影响患儿预后的危险因素,包括患儿的一般情况、产前超声诊断、术前炎症水平等,采用t检验、χ~2检验及Fisher精确概率法进行统计分析。结果·并发症组的入院及手术日龄均大于无并发症组,胎龄、出生体质量均低于无并发症组(均P<0.05),并发症组的C反应蛋白(C-reactive protein,CRP)水平显著高于无并发症组(P=0.048);并发症组产前超声诊断率较无并发症组低,2组比较差异有统计学意义(P=0.039);而2组性别、Apgar评分、手术方式、分娩方式及其他产前超声表现等差异无统计学意义。结论·产前超声确诊、早期手术干预可改善患儿预后,术前CRP水平对胎粪性腹膜炎患儿的预后有一定的预测价值。

Objective · To analyze the clinical features of meconium peritonitis (MP) and the related factors influencing its prognosis.Methods · Fifty-four patients with MP who received surgical intervention at department of pediatric intensive care unit,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine from May 2006 to May 2018 were retrospectively reviewed,and divided into complication group (n=24) and non-complication group (n=30).Risk factors of the two groups after operation were analyzed,including general condition,prenatal diagnosis and preoperative value of C-reactive protein (CRP),independent-samples t test,χ~2 test or Fisher’s exact test.Results · Compared with the non-complication group,days of admission and operation after birth were longer;the gestational age and the birth weight were lower (all P<0.05) in the complication group;the CRP value of the complication group was higher than that of the non-complication group (P=0.048).The prenatal diagnosis percentage of the non-complication group was higher than that of the complication group (P=0.039).However,there was no statistical significance in gender,Apgar score,surgical procedure,delivery type and prenatal ultrasound findings.Conclusion · Prenatal ultrasound detection with MP and early surgical treatment can improve the prognosis,and the preoperative inflammation level has a certain predictive value for the prognosis of children.