高频肠道超声评估新生儿坏死性小肠结肠炎

High frequency intestinal ultrasound for evaluation on neonatal necrotizing enterocolitis

目的 探讨高频肠道超声评估新生儿坏死性小肠结肠炎(NEC)的价值。方法 纳入304例新生儿NEC,根据临床转归将其分为转归不良组(n=64,接受急性期手术治疗)及转归良好组(n=240,接受急性期保守治疗)。比较组间高频肠道超声表现的差异,应用logistic回归分析筛选预测新生儿NEC转归不良的独立因素;绘制受试者工作特征曲线,评估肠道超声征象预测新生儿NEC转归不良的价值。结果 转归不良组64例术中均见肠管坏死或穿孔;转归良好组经内科保守治疗后好转。转归不良组患儿腹腔游离气体、腹腔积液、门静脉积气、肠壁积气、肠壁增厚、肠管扩张及肠梗阻超声检出率均明显高于转归良好组(P均<0.05)。相比转归良好组,转归不良组腹腔积液透声情况更差、深度更深(P均<0.05)。高频肠道超声检出肠梗阻、腹腔积液透声差及腹腔积液深度>18.1 mm是新生儿NEC临床转归不良的独立预测因素(P均<0.05),其联合预测新生儿NEC转归不良的曲线下面积为0.75,敏感度为93.66%,特异度为82.32%。结论 高频肠道超声可用于评估新生儿NEC。

Objective To explore the value of high frequency intestinal ultrasound for evaluation on neonatal necrotizing enterocolitis(NEC).Methods Totally 304 neonatal NEC were enrolled and divided into poor outcome group(n=64,underwent surgical treatment during acute phase)and well outcome group(n=240,underwent conservative treatment during acute phase)according to the clinical outcome.High frequency intestinal ultrasonic signs were compared between groups,and logistic regression analysis was used to filter independent factors for predicting poor outcome of neonatal NEC.Then receiver operating characteristic curve was drawn,and the value of intestinal ultrasound signs for predicting poor outcome in neonatal NEC were evaluated.Results Intestinal necrosis or perforation were observed during operation in all 64 cases of poor outcome group.Symptoms of well outcome group improved with conservative internal medicine treatment during acute phase.The ultrasonic detection rates of free gas,peritoneal effusion,portal venous gas,intestinal wall gas,intestinal wall thickening,intestinal tube dilation and intestinal obstruction in poor outcome group were all significantly higher than those in well outcome group(all P<0.05).Compared with well outcome group,poor outcome group had worse and deeper peritoneal fluid permeability(both P<0.05).The detection of intestinal obstruction,poor sound permeability of peritoneal effusion and depth of peritoneal effusion>18.1 mm with high frequency intestinal ultrasound were independent factors indicating poor clinical outcome in neonatal NEC(all P<0.05),and the area under the curve of the combined prediction of poor outcome in neonatal NEC was 0.75,the sensitivity was 93.66%and the specificity was 82.32%.Conclusion High frequency intestinal ultrasound could be used to evaluate neonatal NEC.