MD量表联合修正Bell分期对早产儿坏死性小肠结肠炎预后预测价值

The predictive value of MD scale combined with modified Bell staging in predicting the prognosis of necrotizing enterocolitis in premature infants

目的应用代谢紊乱评分(MD)量表联合修正Bell分期,对坏死性小肠结肠炎的新生儿病例进行回顾性分析,为提高临床治愈率、评估手术时机、改善预后提供依据。方法采用回顾性分析方法,纳入2019年1月至2022年12月本院NICU收治的NEC早产儿224例,根据修正Bell分期分为IB期、ⅡA期、ⅡB期、Ⅲ期;根据患儿是否有手术治疗指征分为手术组与保守组,根据病情转归分为治愈组、预后不良组,分析MD评分及修正Bell分期与早产儿NEC病情危重程度、手术干预时机选择及预后的相关性。结果依据修正Bell分期,IB期83例,ⅡA期52例,ⅡB期47例,Ⅲ期42例,保守组165例,手术组59例,治愈组141例,预后不良组83例,预后不良组(好转79例、死亡4例)。IB期保守治疗,ⅡA期3例手术,ⅡA期保守组和手术组的预后差异不具有统计学意义(P=1.0);ⅡB期选择手术治疗21例,手术治疗治愈率高于保守治疗治愈率,且预后差异具有统计学意义(χ^(2)=6.300,P=0.012)。Ⅲ期选择保守治疗的患儿7例,其中家属放弃治疗后死亡4例,选择手术治疗患儿35例,手术组治愈率高于保守组治愈率,但Ⅲ期保守组与手术组预后差异无统计学意义(χ^(2)=1.577,P=0.209)。单因素分析MD量表各变量与早产儿NEC预后的相关性,出现酸中毒、PCT升高、低钠血症、血小板减少、低血压、中性粒细胞减少与预后不良的相关性具有统计学意义(P<0.05)。影响NEC早产儿预后的多因素Logistic回归分析显示,手术治疗有利预后(β=2.844),酸中毒(OR=0.076,95%CI:0.025~0.232)、血小板减少(OR=0.173,95%CI:0.065~0.463)、手术治疗(OR=17.178,95%CI:4.330~68.142)对预后的影响差异有统计学意义(P<0.01)。MD≥4在手术组和保守组中的分布差异有统计学意义(χ^(2)=109.895,P<0.01),Bell分期≥ⅡB期在手术组和保守组中的分布差异有统计学意义(χ^(2)=101.859,P<0.01)。结论针对NEC早产儿应用修正Bell分期、MD评分,可预测患儿预后情况,为疾病严重程度评估及手术时机选择提供依据。

Objective Bell stage was modified by metabolic disorder score(metabolic derangement,MD)scale for retrospective analysis of the cases of premature infants with necrotizing enterocolitis(NEC)to provide the basis for improving the clinical cure rate,evaluate the operation timing and improve the prognosis of NEC in premature infants.Method A retrospective analysis method was used,clinical data of 224 premature infants admitted to NICU for NEC in our hospital from January 2019 to December 2022,according to the revised Bell stage,it is divided into IB,ⅡA,ⅡB andⅢ.According to whether the child had surgical treatment,it was divided into the surgical group and the conservative group.According to the disease conversion,it was divided into the cured group,the poor prognosis group.The correlation of MD score and modified Bell stage,severity of NEC and timing of surgical intervention was analyzed.Results According modified Bell stage,83 in IB,52 inⅡA,47 and 42 inⅡB,Ⅲ,165 in the conservative group,59 in the surgery group,141 in the cured group,83 in poor prognosis(79 improved and 4 deaths).Stage IB was followed by conservative treatment,3 stageⅡA operations,the difference in outcome between the conservative group and the surgical group was not statistically significant(P=1.0).21 patients of stageⅡB were selected for surgical treatment,and the cure rate of surgical treatment was higher than that of conservative treatment,and the prognosis was statistically significant(χ^(2)=6.300,P=0.012).There were 7 children who chose conservative treatment in stageⅢ,among which 4 patients died after their family members abandoned treatment,and 35 children chose surgical treatment.The cure rate in the surgical group was higher than that of the conservative group,but the prognosis difference in stageⅢbetween the conservative group and the surgical group was not significant(χ^(2)=1.577,P=0.209).Univariate analysis of the correlation of the variables of MD scale and NEC prognosis in preterm infants found a statistically significant in the association of acidosis,elevated procalcitonin(PCT),hyponatremia,thrombocytopenia,hypotension,and neutropenia with poor prognosis(P<0.05).Multivariate Logistic regression analysis affecting premature infant outcome of NEC showed that surgical treatment favored prognosis(β=2.844),acidosis(OR=0.076,95%CI:0.025~0.232),thrombocytopenia(OR=0.173,95%CI:0.065~0.463),surgical treatment(OR=17.178,95%CI:4.330~68.142)affected prognosis significantly(P<0.01).The difference in MD≥4 distribution in the surgical and conservative groups was statistically significant(χ^(2)=109.895,P<0.01),the distribution of Bell stage≥stageⅡB between the surgical and conservative groups was significant(χ^(2)=101.859,P<0.01).Conclusion Revised Bell stage and MD score in premature NEC infants can predict poor prognosis and surgical correlation,and provide a basis for the evaluation of disease severity and the choice of surgical timing.