摘要目的 探讨新生儿坏死性小肠结肠炎(NEC)的临床特点及预后不良的危险因素.方法 采用回顾性病例研究方法,收集广东省6家医院2005年1月至2014年12月收治的NEC患儿资料,对早产儿和足月儿、早发型与晚发型NEC的临床特点及预后不良的危险因素进行分析.结果 研究期间共有449例符合入选标准患儿,病死率为23.6％(106/449例),其中早产儿组为24.6％(58/238例),足月儿组为22.7％(48/211例),早发型组为22.1％(45/204例),晚发型组为24.3％(57/235例);早产儿NEC发病时间中位数为出生后11d,足月儿NEC为出生后6d;足月儿NEC更多表现为腹胀(52.1％比42.O％,x2 =4.597,P=O.032)、呕吐(36.5％比17.2％,x2=21.428,P=0.000)、血便(30.3％比21.4％,x2=4.653,P =0.031),症状明显,而早产儿NEC初期则主要表现为喂养不耐受(21.0％比12.8％x2=5.309,p=0.021);足月儿早发型NEC组中病例大多为双胎或多胎(9.4％比1.1％,x2=6.226,P=O.013),并且手术治疗率更高(41.0％比27.0％,x2=4.395,P =0.036),足月儿早发型NEC发生前母乳喂养率低于晚发型,差异有统计学意义(14.5％比32.6％,x2=9.500,P=0.002);早产儿早发型NEC组病例的出生胎龄以及出生体质量均较晚发型大[(33.8±2.5)周比(32.2±2.8)周,t=4.261,P=0.000]、[(2.1±0.5) kg比(1.7±0.5)kg,=4.619,P=0.000],住院天数少于晚发型(18 d比26.5 d,t=4.735,P=0.000),差异均有统计学意义;Logistic回归分析显示,足月儿NEC预后不良的危险因素为休克、腹膜炎及脓毒症;早产儿NEC预后不良的危险因素为小于胎龄儿、肺出血、休克、肠穿孔、脓毒症;足月儿早发型NEC组预后不良的危险因素为休克,晚发型组为休克、腹膜炎;早产儿早发型NEC组预后不良的危险因素为休克、脓毒症,晚发型组为肺出血、休克、肠穿孔、脓毒症.结论 与早产儿比较,足月儿NEC的发病时间更早,临床表现更典型;早期识别并处理休克、腹膜炎、肠穿孔、脓毒症及肺出血可降低新生儿NEC预后不良的风险.

abstractsObjective To explore the clinical features and risk factors of poor prognosis in neonatal necrotizing enterocolitis(NEC).Methods A retrospective study was carried out in the infants with NEC admitted to 6 cooperative hospitals in Guangdong Province between January 2005 and December 2014.The clinical features and risk factors of poor prognosis in preterm and full-term infants diagnosed NEC,early onset and late onset NEC were analyzed.Results A total of 449 cases who met the criteria were admitted during the study time.The mortality was 23.6％ (106/449 cases),of which the preterm group was 24.6％ (58/238 cases) while the full-term group was 22.7％ (48/211 cases),the early onset group was 22.1％ (45/204 cases) while the late onset group was 24.3％ (57/235 cases).The median number of NEC onset in preterm group was 11 d after birth while the number of the full-term group was 6 d.Full-term infants who diagnosed NEC were more likely to manifest themselves as abdominal distension (52.1％ vs.42.0％,x2 =4.597,P =0.032),vomiting(36.5％ vs.17.2％,x2 =21.428,P =0.000) and bloody stool(30.3％ vs.21.4％,x2 =4.653,P =0.031);but in the onset of NEC,preterm infants more likely to have feeding intolerance (21.0％ vs.12.8％,x2=5.309,P =0.021).The early onset group of full-term NEC was much common in twins or multiplets(9.4％ vs.1.1％,x2 =6.226,P =0.013),which rate of surgical therapy was much higher (41.0％ vs.27.0％,P =0.036) and the breast-feeding rate before NEC was lower than the late onset group(14.5％ vs.32.6％,x2 =9.500,P =0.002),the differences were statistically significant.The gestational age and birth weight were bigger in the early onset group of preterm NEC[(33.8 ±2.5) weeks vs.(32.2 ±2.8) weeks,t =4.261,P =0.000;(2.1 ±0.5) kg vs.(1.7 ± 0.5) kg,t =4.735,P =0.000)],but length of stay was shorter than the late onset group (18.0 d vs.26.5 d,P =0.000).Logistic regression analysis showed that the risk factors of poor prognosis of full-term NEC were shock,peritonitis and sepsis;while risk factors of poor prognosis of preterm NEC were small for gestational age infant,pulmonary hemorrhage,shock,intestinal perforation and sepsis;the risk factors of poor prognosis of the early onset group of full-term NEC was shock;while those of the late onset group were shock and peritonitis;the risk factors of poor prognosis in the early onset group of preterm NEC were shock and sepsis,while those in the late onset group were pulmonary hemorrhage,shock,intestinal perforation and sepsis.Conclusions Compared to the preterm NEC,the onset time of full-term NEC was earlier and the clinical manifestations were more typical.Early identification and management of shock,peritonitis,intestinal perforation,sepsis and pulmonary hemorrhage can reduce the risk of poor prognosis of neonate NEC.