双胎输血综合征合并新生儿坏死性小肠结肠炎的临床分析

Clinical analysis of twin-to-twin transfusion syndrome combined with necrotizing enterocolitis

目的探讨双胎输血综合征(TTTS)合并新生儿坏死性小肠结肠炎(NEC)的临床特点及高危因素。方法收集2017年1月至2020年1月入住郑州大学第三附属医院NICU确诊为TTTS的102例患儿的临床资料;选取同期住院、同胎龄段未患有TTTS的双胎儿51对,共102例患儿作为对照组,记录其相关的病例资料并进行比较;进一步对TTTS组中合并NEC的14例患儿的临床资料进行回顾性分析。结果(1)TTTS组患儿平均胎龄(32.24±2.12)周,对照组平均胎龄(32.47±1.84)周,差异无统计学意义(P>0.05);TTTS组平均出生体重(1547.63±523.80)g,低于对照组出生体重(1658.71±454.13)g,差异有统计学意义(P<0.05);TTTS组14例患儿合并NEC,发生率为13.7%(14/102),对照组中7例患儿发生NEC,发生率为6.9%(7/102),两组相比差异有统计学意义(P<0.05)。TTTS组极低出生体重儿所占比例、NEC发生于2周内的比例、病死率均高于对照组,差异有统计学意义(P<0.05)。(2)TTTS患儿中,NEC组出生体重较低,宫内窘迫及生后重度窒息的发生率、合并败血症的比例明显高于非NEC组,差异有统计学意义(P<0.05)。(3)TTTS患儿中,确诊NEC的供血儿有10例(71.4%),受血儿4例(28.6%),两组相比差异有统计学意义(P<0.05)。(4)TTTS合并NEC患儿早期临床症状主要表现为血便、腹胀、反应差、呼吸暂停、呕吐等。结论TTTS是NEC发生的高危因素之一,且TTTS合并NEC的发生时间与经典的NEC发生时间并不完全一致,更易在生后2周内发生。TTTS合并NEC多发生在供血儿,胎儿宫内窘迫、重度窒息及合并败血症是TTTS并发NEC的高危因素。TTTS合并NEC患儿早期临床症状与常规NEC并无明显差异,当患儿出现血便、腹胀、反应差、呼吸暂停、呕吐等消化系统症状时应高度警惕。

Objective To investigate clinical characteristics and high-risk factors of prognosis of twin-to-twin transfusion syndrome(TTTS)combined with necrotizing enterocolitis(NEC).Methods The clinical data of 102 children with TTTS admitted to the NICU at the Third Affiliated Hospital of Zhengzhou University from January 2017 to January 2020 were collected.Fifty-one pairs(102 cases)of twins without TTTS who were hospitalized at the same time and in the same gestational age were selected as the control group,and the relevant case data were collected and compared.The clinical data of 14 children with NEC in TTTS group were analyzed retrospectively.Results(1)The average gestational age of TTTS group was(32.24±2.12)weeks,and that was(32.47±1.84)weeks in control group,with no statistical significance(P>0.05).The average birth weight of TTTS group was(1547.63±523.80)g,which was lower than that of control group(1658.71±454.13)g(P<0.05).There were 14 children in TTTS group with NEC,with an incidence of 13.7%(14/102),and seven children in the control group with NEC,with an incidence of 6.9%(7/102)(P<0.05).The proportion of very low birth weight infants,NEC occurrence within 2 weeks and mortality in TTTS group were higher than those in control group(P<0.05).(2)Compared with the non-NEC group,the NEC group of TTTS children had lower birth weight,the incidence of intrauterine distress and severe postnatal asphyxia,and the rate of sepsis were significantly higher than those in non-NEC group(P<0.05).(3)Among TTTS children,NEC was diagnosed in ten donors(71.4%)and four recipients(28.6%),with statistically significant difference between two groups(P<0.05).(4)The early clinical symptoms of TTTS complicated with NEC were mainly bloody stools,abdominal distension,poor response,apnea,and vomiting.Conclusion TTTS is one of the risk factors for NEC,which the occurrence time of TTTS combined with NEC is not completely consistent with the classic NEC,which is more likely to occur within 2 weeks after birth.Children with TTTS complicated with NEC mostly occur in donor infants,and fetal distress in utero,severe asphyxia and sepsis are the high risk factors.The early clinical symptoms of TTTS combined with NEC are not significantly different from those of common NEC,mainly including bloody stools,abdominal diste,poor response,apnea,and vomiting.Vigilance should be raised when similar digestive symptoms appear in children.