摘要目的:探讨新生儿坏死性小肠结肠炎（necrotizing enterocolitis，NEC）患儿需手术治疗的危险因素。方法:选择2016年1月至 2020年7月广州医科大学附属妇女儿童医疗中心诊断为Bell分期Ⅱ期及以上的NEC患儿进行回顾性分析，按照是否需要手术治疗分为手术组和保守组。收集两组患儿的围产期情况、临床特点、发病时实验室指标，应用SPSS 26.0统计软件分析两组差异有统计学意义的指标，并进一步纳入多因素 Logistic回归分析。结果:共纳入NEC患儿177例，其中手术组62例（35.0%），保守组115例（65.0%）。多因素Logistic回归分析显示，男婴（ OR=3.178，95% CI 1.457~6.929， P=0.004）、合并休克（ OR=3.434，95% CI 1.112~10.607， P=0.032）、发病前有创呼吸支持时间>7 d（ OR=3.663，95% CI 1.098~12.223， P=0.035）及发病时淋巴细胞绝对值小于2.0×10 9/L（ OR=4.121，95% CI 1.801~9.430， P=0.001）是NEC患儿需手术治疗的独立危险因素。 结论:男婴、合并休克、发病前使用有创呼吸机时间>7 d及发病时淋巴细胞减少是Bell Ⅱ期及以上NEC患儿需手术治疗的独立危险因素。

abstractsObjective:To study the risk factors of surgical therapy in neonates with necrotizing enterocolitis (NEC).Methods:From January 2016 to July 2020, neonates with a confirmed diagnosis of NEC (Bell's Stage Ⅱ and above) admitted to our hospital were retrospectively enrolled. They were assigned into surgical group and conservative group according to whether surgeries were performed. The conditions during perinatal period, clinical characteristics and laboratory examinations at the onset of NEC were compared between the two groups. Multivariate Logistic regression analysis was used to determine the risk factors of surgical therapy.Results:A total of 177 neonates with NEC were identified, including 62 cases (35.0%) in the surgical group and 115 cases (65.0%) in the conservative group. Multivariate Logistic regression analysis showed that male gender ( OR=3.178,95% CI 1.457~6.929, P=0.004), comorbidity with shock ( OR=3.434, 95% CI 1.112~10.607, P=0.032), mechanical ventilation>7 d before NEC onset ( OR=3.663, 95% CI 1.098~12.223, P=0.035) and lymphocytes <2.0×10 9/L ( OR=4.121, 95% CI 1.801~9.430, P=0.001) at the onset of NEC were independent risk factors for surgical therapy. Conclusions:Male gender, comorbidity with shock, mechanical ventilation >7 d before NEC and lymphocytopenia at the onset are independent risk factors for surgical therapy in neonates with NEC (Stage Ⅱ and above).