新生儿坏死性小肠结肠炎的临床分析

田云粉; 李利; 米弘瑛; 皇甫春荣; 何山; 许小艳; 曹永久

新生儿坏死性小肠结肠炎的临床分析

1. 云南省第一人民医院儿科
2. 云南省第一人民医院遗传诊断中心

基金项目:

基金：云南省应用基础研究计划资助项目 (2012FB204);

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出版历程
- 收稿日期: 2017-09-22

The Clinical Analysis of Necrotizing Enterocolitis

Funds:

基金：云南省应用基础研究计划资助项目 (2012FB204);

摘要

摘要: 目的对2010年5月至2013年5月及2013年6月至2016年6月云南省第一人民医院儿科新生儿病区诊断为坏死性小肠结肠炎 (necrotizing enterocolitis, NEC) 的患儿进行临床分析及比较, 了解NEC的发生率、NEC分期与预后的关系, 并对前后3 a NEC的转归进行比较分析, 为以后的临床工作提供诊治经验.方法对云南省第一人民医院诊断为NEC的患儿临床资料进行回顾性分析, 按照改良Bell分级诊断标准进行病情分期, 用SPSS统计软件包, 并对前后3 a NEC患儿的早期诊断率、转归进行比较差异有统计学意义 (P<0.05) .结果前3 a云南省第一人民医院共诊断了40例NEC患儿, 1发病率早产儿与足月儿经比较差异有统计学意义 (P<0.05) .治疗方法中32例内科保守治, Ⅰ期与Ⅱ期内科治疗比较差异有统计学意义 (P<0.05) .10例手术治疗的患儿, 外科治疗效果比较差异无统计学意义 (P>0.05) , Ⅱ期和Ⅲ期病人治疗的有效率无统计学意义.病死率比较差异有统计学意义 (P<0.05) .后3 a该院共诊断为NEC患儿41例, 发病率早产儿与足月儿经比较差异有统计学意义 (P<0.05) .35例经内科保守治疗, Ⅰ期与Ⅱ期内科治疗比较, 差异有统计学意义 (P<0.05) .4例手术治疗患儿, Ⅱ期与Ⅲ期手术治愈率比较差异无统计学意义, 前后3 a病死率比较差异有统计学意义 (P<0.05) , 住前后3 a早期诊断率比有统计学意义 (P<0.05) .结论早期诊断NEC是降低病死率的关键, 而肠型脂肪酸结合蛋白 (I-FABP) 是早期诊断NEC的血清学指标, 降低早产儿发生率是降低NEC发病率的重要因素.
- 坏死性小肠结肠炎 /
- 新生儿 /
- 肠型脂肪酸结合蛋白
Abstract: Objective From May 2010 to May 2013 and from June 2013 to June 2016, we compared the clinical analysis of patients with necrotizing enterocolitis (NEC) in the Department of Pediatrics, studied incidence rate of NEC and the relationship between stages of NEC and prognosis, and compared the prognosis between the two three-year periods to provide the experience of diagnosis and treatment for clinical practice in the future. Me thods The clinical data of patients diagnosed with NEC were retrospectively analyzed according to the diagnostic criteria of modified Bell staging classification using SPSS statistical software package. Early diagnosis rate and prognosis were compared between the two three-year periods. P <0.05 showed that statistical significance was found. Re s ults From May 2010 to May 2013, 40 cases of NEC were diagnosed in our hospital, among which 8 was in the first stage (20%) , 24 in the second stage (60%) , and 8 in the third stage (20%) . The number of premature infants was 32, accounting for 80%, among which 25 cases were infants with very low birth weight accounting for 62.5% and 8 cases were full-term infants, accounting for 20% (P < 0.05) . In the study, 32 cases (80%) received traditional treatment, which was effective in stage I. During the second stage, two abandoned the treatment was confirmed death in the follow-up, two underwent surgery successfully due to the progression of the disease and four (25%) died in the hospital. Statistic significance of treatment of internal medicine was found when comparing stage I with stage II (P<0.05) . Ten children underwent surgery, among which one gave up treatment after the surgery because of financial problems and was found dead in the follow-up and four (60%) died in the hospital. The comparison of surgical treatment in patients in stage II and III showed no statistical significance (P>0.05) . Fatality rates were statistically significant (P<0.05) . From June 2013 to June 2016, 41 children were diagnosed with NEC in our hospital, including 24 cases in stage I (59%) , 14 in stage II (34%) , and 3 in stage III (7%) . The number of premature infants was 33, accounting for 80%, among which 26 cases were infants with very low birth weight accounting for 62.5% and 8 cases were full-term infants, accounting for 20% (P<0.05) . In the study, 35 cases (85.3%) received traditional treatment, which was effective in stage I. During the second stage, one underwent surgery successfully due to the progression of the disease. Statistic significance of treatment of internal medicine was found when comparing stage I with stage II (P<0.05) . Four children underwent surgery, among which one gave up treatment after the surgery because of financial problems and was found dead in the follow-up and the surgery was successful in other three. The comparison of surgical treatment in patients in stage II and III showed statistical significance (P <0.05) . Fatality rates were statistically significant comparing the two three-year periods (P<0.05) . The comparison of the rates of early diagnosis in the two three-year periods showed statistically significance (P <0.001) . Conclus ion Early diagnosis of NEC is the key to reduce mortality.Intestinal fatty acid binding protein (I-FABP) is a serological marker for early diagnosis of NEC. As an important factor, the reduction of the incidence of premature birth will result in the drop in the incidence of NEC.
- Necrotizing Enterocolitis (NEC) /
- Newborn /
- Intestinal fatty acid binding protein

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参考文献(12)

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