肠闭锁术后坏死性小肠结肠炎危险因素分析

Risk factors of necrotizing enterocolitis after surgery for intestinal atresia

目的探讨肠闭锁术后发生坏死性小肠结肠炎(necrotizing enterocolitis,NEC)的危险因素。方法回顾性选择2013年8月至2020年6月在广州市妇女儿童医疗中心因肠闭锁接受手术治疗的患儿为研究对象,按照肠闭锁术后是否发生NEC分为NEC组和非NEC组,比较两组患儿基本资料和临床特征,采用Logistic回归分析肠闭锁术后发生NEC的危险因素。结果共纳入肠闭锁术后患儿96例,NEC组13例(13.5%),非NEC组83例(86.5%)。与非NEC组相比,NEC组患儿初诊日龄晚[4.0(1.5,6.0)d比1.4(0,2.0)d]、手术日龄晚[4.8(2.0,7.0)d比3.1(1.0,4.0)d]、复杂型肠闭锁[76.9%(10/13)比44.6%(37/83)]及术后48 h内输血[46.2%(6/13)比13.3%(11/83)]比例高,差异均有统计学意义(P<0.05)。Logistic回归分析显示,初诊日龄晚(OR=3.346,95%CI 1.493~7.500,P=0.003)、复杂型肠闭锁(OR=9.052,95%CI 1.119~73.209,P=0.039)及术后48 h内输血(OR=6.835,95%CI 1.399~33.380,P=0.018)是术后NEC的独立危险因素。结论临床上肠闭锁诊断延迟、复杂型肠闭锁及术后48 h内输血的患儿,应警惕术后NEC的发生。

Objective To study the risk factors of necrotizing enterocolitis(NEC)after surgery for intestinal atresia.Method From August 2013 to June 2020,children with intestinal atresia receiving surgery in our hospital were retrospectively reviewed.The patients were assigned into NEC group and non-NEC group according to the occurrence of postoperative NEC.Demographic data and clinical characteristics were summarized and the risk factors for postoperative NEC were analyzed using Logistic regression analysis method.Result A total of 96 infants were enrolled and NEC occurred in 13 patients(13.5%)after surgery for intestinal atresia.Compared with the non-NEC group,the NEC group were diagnosed of intestinal atresia[4.0(1.5,6.0)d vs.1.4(0,2.0)d,P<0.001]and received surgery[4.8(2.0,7.0)d vs.3.1(1.0,4.0)d,P=0.034]at later ages.The incidences of complex intestinal atresia[76.9%(10/13)vs.44.6%(37/83),P=0.030]and blood transfusion[46.2%(6/13)vs.13.3%(11/83),P=0.007]in the NEC group were higher than the non-NEC group.Logistic regression analysis showed that the age of initial diagnosis of intestinal atresia(OR=3.346,95%CI 1.493~7.500,P=0.003),complex intestinal atresia(OR=9.052,95%CI 1.119~73.209,P=0.039)and blood transfusion(OR=6.835,95%CI 1.399~33.380,P=0.018)were independent risk factors for postoperative NEC.Conclusion Patients with delayed diagnosis of intestinal atresia,complex intestinal atresia and blood transfusion within 48 hours after surgery should be monitored for the occurrence of postoperative NEC.