早产儿坏死性小肠结肠炎并脑损伤的临床特点

Clinical characteristics of necrotizing enterocolitis with brain injury in premature infants

目的:探讨早产儿坏死性小肠结肠炎(NEC)并脑损伤的临床发病特点及影像学变化。方法:回顾性分析94例NECⅡ期或Ⅲ期早产儿临床资料,脑MRI异常为观察组(35例),脑MRI正常为对照组(59例),分析两组患儿一般临床资料、实验室检查及脑MRI。结果:两组比较,观察组NECⅢ期、新生儿败血症和动脉导管未闭(PDA)发生率高(P<0.05);观察组血小板计数减少,凝血酶原时间(PT)延长,差异均有统计学意义(P<0.05)。NEC并发脑损伤发生率37.23%。NECⅡ期与Ⅲ期患儿脑MRI比较,NECⅢ期脑损伤发生率高(51.22%vs 26.41%,P<0.01),且重度脑损伤多,表现为重度脑白质损伤(P<0.01)及Ⅲ~Ⅳ级脑室周围-脑室内出血(P<0.01)。NECⅢ期并脑损伤组死亡率高。结论:早产儿NEC合并新生儿败血症、PDA、血小板减少及PT延长更易致脑损伤。与NECⅡ期比较,NECⅢ期脑损伤多见且更严重。

Objective:To investigate the clinical features and magnetic resonance imaging(MRI)changes of necrotizing enterocolitis(NEC)complicated with brain injury in premature infants.Methods:We retrospectively analyzed the clinical data of 94 infants with NEC stageⅡorⅢ.The cases were divided into an observation group(35 cases)with abnormal brain MRI and a control group(59 cases)with normal brain MRI.The general clinical data,laboratory examination,and brain MRI of the two groups were studied.Results:Compared with that respectively in the control group,the incidence of NEC stageⅢ,neonatal sepsis,or patent ductus arteriosus(PDA)in the observation group was higher(P<0.05);platelet count decreased and prothrombin time(PT)prolonged in the observation group,with statistically significant difference(P<0.05).The incidence of NEC complicated with brain injury was 37.23%.Compared with the findings of the brain MRI between NEC stageⅡand stageⅢ,the incidence of NEC stageⅢbrain injury was higher(51.22%vs 26.41%,P=0.014),and more severe brain injury was found,manifested as severe white matter injury(P<0.01)and gradeⅢ-Ⅳperiventricular-intraventricular hemorrhage(P<0.01).A higher mortality rate was found in NEC stageⅢpatients with brain injury.Conclusion:Neonatal sepsis,PDA,thrombocytopenia,and PT prolongation are more likely to cause brain injury in premature NEC.Compared with that in the NEC stageⅡ,brain injury in the NEC stageⅢis common and more serious.