新生儿窒息后胃肠道功能损伤的临床分析

Clinical analysis of gastrointestinal dysfunction after neonatal asphyxia

目的探讨新生儿窒息后胃肠道功能损伤的临床表现及相关危险因素。方法回顾性分析159例新生儿窒息患儿,依据Apgar评分分为轻度窒息组和重度窒息组,比较两组胃肠损伤及喂养不耐受、消化道出血、明显腹胀、肠鸣音减弱的发生情况;并依据胃肠损伤程度分为轻症和重症,采用χ^2检验比较其发生率;采用logistic回归分析胃肠道功能损伤的相关危险因素。结果轻度窒息组136例,重度窒息组23例,两组发生胃肠道功能损伤共60例,其中轻度窒息组44例(32.4%),重度窒息组16例(69.6%),两组差异有统计学意义(χ^2=11.59,P<0.01);轻度窒息组发生胃肠损害重症为12例、轻症32例,重度窒息组重症12例、轻症4例,(χ^2=12.27,P<0.01);轻度窒息组在24 h和48 h开奶发生喂养不耐受、胃潴留、胃肠出血、腹胀情况均明显低于重度窒息组(χ^2分别为3.227、39.380,53.550、30.390,5.118、8.280,14.300、13.440,P值均<0.05)、两组肠鸣音减弱发生率无明显差异(P值均>0.05);轻度窒息组72 h开奶时发生喂养不耐受、胃肠出血发生情况均低于重度窒息组(χ^2分别为28.690,5.400,P值均<0.05),两组胃潴留、明显腹胀、肠鸣音减弱发生率均无明显差异(P值均>0.05)。窒息程度、Apgar 1 min评分,24、48 h开奶,多脏器功能损伤是发生胃肠道功能损伤的独立危险因素(OR分别为26.267、1.557、4.946、8.132、2.880;P值均<0.05)。结论新生儿窒息后胃肠道功能损伤发生率较高,窒息程度与胃肠道功能损伤呈正相关。

Objective To investigate the clinical manifestations and related risk factors of gastrointestinal dysfunction after having neonatal asphyxia.Methods According to the Apgar score,using a retrospective analysis,159 newborns with asphyxia were divided into two groups:mild asphyxia and severe asphyxia,then were compared the occurrence of gastrointestinal injury,feeding intolerance,gastrointestinal bleeding,obvious abdominal distension,and attenuated borborygmus sounds between the two groups.These newborns were also divided into mild gastrointestinal dysfunction and severe gastrointestinal dysfunction groups and compared the above indexes incidence.The related risk factors of gastrointestinal function damage were analyzed by logistic regression.Results There were 136 cases in the mild asphyxia group,23 cases in the severe asphyxia group.60 cases of gastrointestinal dysfunction occurred in the two groups,including 44 cases(32.4%)in the mild asphyxia group and 16 cases(69.6%)in the severe asphyxia group(χ^2=11.59,P<0.01);Gastrointestinal damage in the mild asphyxia group included 12 severe cases and 32 mild cases.12 severe cases and 4 mild cases in the severe asphyxia group,(χ^2=12.27,P<0.01);The occurrence of feeding intolerance,gastric retention,gastrointestinal bleeding,and abdominal distension in the mild asphyxia group at 24 h(24 h after birth start breatfeeding)and 48 h(48 h after birth start breatfeeding)were significantly lower than those in the severe asphyxia group(χ^2=3.227,39.380;53.550,30.390;5.118,8.280;14.300,13.440;all P<0.05).There was no significant difference in the attenuated borborygmus sounds in the two groups(all P>0.05);In the mild asphyxia group,feeding intolerance and gastrointestinal bleeding occurred at 72 h(72 h after birth start breatfeeding)were lower than those in the severe asphyxia group(χ^2=28.690,5.400;all P<0.05).There was no significant difference in the occurrence of gastric retention,obvious abdominal distension,and attenuated borborygmus sounds between the two groups(all P>0.05);the degree of asphyxia,Apgar 1 min score,24 h(24 h after birth start breatfeeding),48 h(48 h after birth start breatfeeding),and multiple organ dysfunction are independent risk factors for gastrointestinal dysfunction(OR=26.267,1.557,4.946,8.132,2.880;all P<0.05).Conclusion The incidence of gastrointestinal damage is higher in neonates after asphyxia,and the degree of asphyxia is positively correlated with gastrointestinal damage.