新生儿空肠闭锁术后发生坏死性小肠结肠炎的危险因素分析

Potential risk factors of postoperative necrotizing enterocolitis in neonates after operations for jejunum atresia

目的探讨新生儿空肠闭锁术后坏死性小肠结肠炎(postoperative necrotizing enterocolitis,PONEC)的危险因素。方法回顾性分析山西省儿童医院外科2010年1月至2018年12月所有因新生儿空肠闭锁行一期肠吻合术患儿的临床资料,根据术后90 d内是否发生PONEC将患儿分为PONEC组与非PONEC组,收集和分析术前、术中及术后与PONEC发病相关的因素。采用Kaplan-Meier法分析两组患儿术后90 d内的生存曲线并进行Log-rank检验,采用Cox比例风险模型(逐步前进法)筛选PONEC的危险因素。结果共纳入108例空肠闭锁新生儿,PONEC组10例,非PONEC组98例,PONEC发生率为9.26%(10/108)。非PONEC组患儿术后90 d内病死率为7.14%(7/98),PONEC组为50%(5/10),组间比较差异有统计学意义(χ^2=18.503,P<0.01)。Cox比例风险模型分析结果显示,低出生体重、术后发生严重贫血及经鼻空肠管管饲是导致PONEC的危险因素(P=0.002、0.043和0.005),相对危险度分别为0.216、0.144、0.118。结论空肠闭锁术后加强对低出生体重、NJT管饲及重度贫血患儿的管理,有望降低PONEC的发生率及病死率。

Objective To explore potential risk factors of postoperative necrotizing enterocolitis(PONEC)in neonates after operations for jejunum atresia(JA).Methods From January 2010 to December 2018,clinical data were retrospectively analyzed for 108 JA neonates undergoing intestinal anastomosis.They were divided into PONEC(n=10)and non-PONEC(n=98)groups according to whether neonatal necrotizing enterocolitis(NEC)occurred within 90 days postoperatively.Also peripostoperative factors associated with an onset of NEC were examined.The counting data were analyzed by Pearson's chi-square test and measurement data processed by independent sample t-test.Kaplan-Meier survival analysis was performed for plotting the survival curves of two groups and log-rank test conducted.Cox proportional hazard model was constructed for assessing the risk factors of PONEC.Results The incidence of PONEC was 9.26%.The mortality of non-PONEC group was 7.14%and PONEC 50%within 90 days postoperatively.The survival curve of non-PONEC group was significantly better than that of PONEC group(χ^2=18.503,P<0.01).Cox proportional risk modeling indicated that low birth weight,severe anemia and postoperative nasojejunal tube(NJT)feeding were risk factors for PONEC.Conclusions PONEC is associated with multiple risk factors of low birth weight,postoperative anemia and postoperative NJT feeding.Close monitoring may allow clinicians to intervene or reduce the risk of PONEC.