新生儿坏死性小肠结肠炎造瘘术后肠衰竭相关性肝病的影响因素分析

Analysis of influencing factors of intestinal failure associated liver disease after enterostomy in neonatal necrotizing enterocolitis

目的 分析新生儿坏死性小肠结肠炎(neonatal necrotizing enterocolitis,NEC)造瘘术后肠衰竭相关性肝病(intestinal failure associated liver disease,IFALD)的影响因素。方法 采用回顾性研究方法,选取2018年1月1日至2022年1月31日在解放军总医院第七医学中心收治的初诊为NEC并行肠造瘘及还纳手术的78例患儿为研究对象。根据患儿是否合并IFALD分为未合并IFALD组(n=51)与合并IFALD组(n=27)。分析两组患儿的临床资料,并对术后发生IFALD的相关因素进行分析。统计学方法采用χ^(2)检验、t检验以及多因素Logistic回归分析。结果 合并IFALD组与未合并IFALD组的早产儿比例分别为[92.6%(25/27)与72.5%(37/51),χ^(2)=4.084,P=0.043];低出生体质量儿比例分别为[88.9%(24/27)与70.6%(36/51),χ^(2)=4.722,P=0.030];造瘘术后剩余小肠长度<40 cm的比例分别为[37.0%(10/27)与5.9%(3/51),χ^(2)=12.764,P=0.001];并发脓毒血症发生率分别为[37.0%(10/27)与11.8%(6/51),χ^(2)=7.456,P=0.039],合并IFALD组均高于未合并IFALD组,且差异均有统计学意义。合并IFALD组与未合并IFALD组患儿的术后开奶天数分别为[(10±5)与(9±4)d,t=-1.241,P=0.021];达到全肠道喂养所需平均天数分别为[(50±19)与(27±13)d,t=3.341,P<0.001],合并IFALD组均长于未合并IFALD组。多因素Logistic分析显示,达到全肠道喂养所需天数与IFALD发生呈正相关(OR=1.075,P=0.001),并发脓毒血症与IFALD发生呈正相关(OR=5.427,P=0.027)。结论 NEC小肠造瘘术后患儿,待病情稳定后早日达到全肠道喂养,积极预防感染是改善IFALD结局的重要因素。

Objective To analyze the influencing factors and interventions of intestinal failure associated liver disease(IFALD) fistula after enterostomy in neonatal necrotizing enterocolitis(NEC). Method From January 1, 2018 to January 31, 2022, 78 neonates with NEC who underwent enterostomy and repayment surgery in the Seventh Medical Center of PLA General Hospital were selected as the research objects by a retrospective study method. According to the presence or absence of IFALD, the children were divided into the non-IFALD group(n=51) and the IFALD group(n=27). The clinical data of the two groups were analyzed,and the related factors of IFALD after operation were analyzed. Chi-square test, t-test and multivariate Logistic regression were used for statistical analysis. Result The proportion of preterm infants in the IFALD group and the non-IFALD group were [92.6%(25/27) vs 72.5%(37/51), χ^(2)=4.084, P=0.043], respectively;the proportion of low birth weight infants were [88.9%(24/27) vs 70.6%(36/51), χ^(2)=4.722, P=0.030], respectively;the proportion of residual small intestine length <40 cm after enterostomy were [37.0%(10/27) vs 11.8%(6/51), χ^(2)=7.456, P=0.039], respectively;the incidence of sepsis was [37.0%(10/27) vs 5.9%(3/51), χ^(2)=12.764, P=0.001];Which in the IFALD group were all higher than those in the non-IFALD group, and the difference were statistically significant. The days of postoperative lactation in IFALD group and non-IFALD group were [(10±5) vs(9±4) d, t=-1.241, P=0.021], respectively. The number of days needed to reach whole intestinal feeding were [(50±19) vs(27±13) d, t=3.341, P<0.001], respectively;and the IFALD group was all longer than the non-IFALD group, and the difference were statistically significant. Multivariate Logistic analysis showed that the number of days to complete enteral feeding was positively correlated with the occurrence of IFALD(OR=1.075, P=0.001). Sepsis was positively correlated with IFALD(OR=5.427, P=0.027). Conclusion The children with NEC after enterostomy should be fed as soon as possible when their condition is stable, and actively prevent infection are important factors to improve the outcome of IFALD.