摘要
目的:探讨早产儿消化道穿孔的病因,分析影响早产儿消化道穿孔短期预后不良的危险因素。方法:回顾性分析山西省儿童医院新生儿外科2015年1月—2021年5月诊治的89例早产儿消化道穿孔的临床资料。根据术后3个月时结局分为生存组和预后不良组。比较两组术前、术中及术后与早产儿消化道穿孔预后不良相关的因素,采用Logistic回归分析筛选早产儿消化道穿孔预后不良的危险因素。结果:早产儿消化道穿孔的病死率为25.84%,坏死性小肠结肠炎(NEC)和胃壁肌层缺损是早产儿消化道穿孔常见的病因。单因素分析显示生存组患儿从发现气腹至手术时间在8 h之内的比例显著高于预后不良组(χ^(2)=15.22,P<0.01)。预后不良组合并脓毒性休克的比例显著高于生存组(χ^(2)=33.19,P<0.01)。预后不良组术后合并需非计划二次手术的并发症比例显著高于生存组(χ^(2)=7.24,P<0.01)。Logistic回归分析显示脓毒性休克(OR=0.06,95%CI:0.02~0.21,P<0.01)和气腹至手术时间大于8 h(OR=0.23,95%CI:0.07~0.81,P<0.05)是早产儿消化道穿孔短期预后不良的危险因素。结论:NEC和胃壁肌层缺损是早产儿消化道穿孔的主要病因,脓毒性休克和从气腹发生至手术时间大于8 h是早产儿消化道穿孔短期预后不良的危险因素。
Objective:To investigate the etiology of gastrointestinal perforation in preterm neonates and to explore the risk factors for poor short-term prognosis.Methods:The clinical data of 89 cases of gastrointestinal perforation in preterm neonates treated in Children's Hospital of Shanxi Province from January 2015 to May 2021 were analyzed retrospectively.They were divided into survival group and poor prognosis group according to the outcome at 3 months postoperation.The factors may be related to the poor prognosis of gastrointestinal perforation in preterm neonates before,during and after operation were compared between the two groups.Logistic regression analysis was used to screen the risk factors of poor prognosis of gastrointestinal perforation in preterm neonates.Results:The mortality of gastrointestinal perforation in preterm neonates was 25.84%.Necrotizing enterocolitis(NEC)and congenital defects of gastric musculature were major causes of gastrointestinal perforation in preterm neonates.Univariate analysis showed that the proportion of patients operated within 8 hours after the discovery of pneumoperitoneum in survival group was significantly higher than that in poor prognosis group(χ^(2)=15.22,P<0.01).The proportion of septic shock in the poor prognosis group was significantly higher than survival group(χ^(2)=33.19,P<0.01).The incidence of complications requiring unplanned secondary operation was higher in the poor prognosis group than that in the survival group(χ^(2)=7.24,P<0.01).Logistic regression analysis showed that septic shock(OR=0.06,95%CI:0.02-0.21,P<0.01)and more than 8 hours from pneumoperitoneum to operation(OR=0.23,95%CI:0.07-0.81,P<0.05)were risk factors for poor short-term prognosis of gastrointestinal perforation in preterm neonates.Conclusion:NEC and congenital defects of gastric musculature are common causes of gastrointestinal perforation in premature neonates.Septic shock and more than 8 hours from pneumoperitoneum to operation are risk factors for poor short-term prognosis of gastrointestinal perforation in premature neonates.
作者
吴晓霞
任红霞
詹江华
WU Xiao-xia;REN Hong-xia;ZHAN Jiang-hua(Graduate College,Tianjin Medical University,Tianjin 300070,China;Department of Pediatric Surgery,Children's Hospital of Shanxi Province,Taiyuan 030013,China;Department of Pediatric Surgery,Tianjin Children's Hospital,Tianjin 300134,China)
出处
《天津医科大学学报》
2022年第3期301-304,共4页
Journal of Tianjin Medical University
基金
山西省重点研发计划项目(201803D31181)。
关键词
早产儿
消化道穿孔
病因
预后
危险因素
premature
gastrointestinal perforation
etiology
prognosis
risk factors
