苏嘉鸿

[摘要]目的分析新生儿坏死性小肠结肠炎（NEC）的临床特点与手术相关危险因素。方法回顾性选取2014年1月至2019年12月中山市博爱医院收治的86例 NEC 新生儿，43例行手术治疗患儿为手术组，43例行非手术治疗患儿为非手术组，收集临床资料，分析手术相关危险因素。结果手术组患儿的性别、胎龄、出生体重和出生至发病的时间与非手术组患儿比较差异无统计学意义（P >0.05）;但手术组位于临床Ⅲ期例数、剖宫产率和分娩时合并宫内感染例数明显高于非手术组，差异有统计学意义（P <0.05）。手术组的43例 NEC 新生儿中，治愈34例（79.07%），死亡9例（20.93%）。代谢性酸中毒、术前使用呼吸机、多处肠段穿孔及广泛病变是影响新生儿 NEC 手术治疗预后的危险因素（ P <0.05）。发病至手术时间<1 d 是影响新生儿 NEC 手术治疗预后的保护因素（ P <0.05）。结论影响新生儿 NEC 手术治疗预后的危险因素较多，应当制订针对性干预措施降低术后病死率。

[关键词]新生儿;坏死性小肠结肠炎;手术;危险因素

[中图分类号] R722.1  [文献标识码] A   [文章编号]2095-0616（2021）24-0104-03

Clinical characteristics of neonatal necrotizing enterocolitis and analysis of risk factors related to surgery

SU  Jiahong

Department of Pediatric Surgery， Boai Hospital of Zhongshan， Guangdong， Zhongshan 528400， China

[Abstract] Objective To analyze the clinical features of neonatal necrotizing enterocolitis （NEC） and the risk factors related to operation. Methods A total of 86 NEC newborns admitted to Boai Hospital of Zhongshan from January 2014 to December 2019 were retrospectively selected， including 43 children who were treated with surgery as the operation group and 43 children who were treated with non-surgery as the non-operation group. The clinical data were collected and the risk factors related to surgery were analyzed. Results There were no significant differences in gender， gestational age， birth weight and the time from birth to onset between the operation group and the non- operation group （P >0.05）. However， the number of patients at stage Ⅲ ， cesarean section rate and intrauterine infection during delivery in the operation group were higher than those in the non-operation group， with statistically significant differences （P <0.05）. Among 43 NEC newborns in the operation group， 34 cases （79.07%） were cured and 9 cases （20.93%） died. Metabolic acidosis， preoperative use of breathing machine， multiple intestinal perforation and extensive pathological changes were risk factors affecting the prognosis of patients with neonatal NEC after surgery （P <0.05）. The time from onset to operation less than 1 day was a protective factor affecting the prognosis of newborns with NEC after surgery （P <0.05）. Conclusion There are many risk factors affecting the prognosis of newborns with NEC after surgery， and targeted interventions should be made to reduce postoperative mortality.

[Key words] Newborn; Necrotizing enterocolitis; Operation; Risk factor

坏死性小肠结肠炎（necrotic enterocolitis， NEC）是各种原因导致肠道感染而发生的肠管坏死性疾病，是新生儿比较严重的消化道急症，多见于出生体重较轻的早产儿[1]。随着早产儿存活率不断增高，新生儿 NEC 的发生率也越来越高[2]。腹胀、呕吐及便血是新生儿 NEC 的主要临床症状，病情严重时会引起患儿肠穿孔而导致大量出血，对新生儿健康造成极大威胁。因此，一旦确诊需要评估是否进行手术治疗[3]。NEC 是导致新生儿进行消化道手术的主要因素之一，可引起新生儿20%～40%的高死亡率，且治疗后常伴随神经发育迟缓、吸收不良等后遗症[4]，因此改善手术预后尤其重要。目前，临床上关于新生儿 NEC 手术治疗相关因素的研究报道比较少见，且无确切定论[5]。基于此，本研究采用单因素方差分析和對多因素进行 logistic 回归分析，探讨新生儿 NEC 手术相关因素及影响患儿手术治疗预后的危险因素，为预防新生儿 NEC 疾病发展和改善手术预后提供科学依据，以期为临床提供参考。