【摘要】 目的:探讨新生儿坏死性小肠结肠炎(NEC)并发肠穿孔的临床特点以对其预后情况进行评估。方法:回顾性收集93例经手术治疗的NEC并发肠穿孔患儿的临床资料。根据患儿预后将其分为良好组(69例)及不良组(24例),采用单因素和多因素Logistic回归分析影响其预后的危险因素。结果:93例患儿多数为早产儿(83.9%)及低出生体重儿(80.6%),合并症以低蛋白血症(45.2%)、低钾血症(39.8%)为主,术中发现以小肠穿孔(52.7%)、单处穿孔多见(79.6%)。患儿合并低蛋白血症(OR=2.077,95%CI:1.931～31.889)、凝血功能障碍(OR=22.829,95%CI:7.063～532.608)及穿孔数目≥2处(OR=3.209,95%CI:1.623～126.806)为预后不良的独立危险因素(均P<0.05)。上述独立危险因素联合对预后不良预测的ROC曲线下面积为0.862(95%CI:0.764～0.961,P<0.001),特异性和敏感度分别为83.3%、77.1%。结论:NEC并发肠穿孔病情复杂、不良预后发生率较高,患儿合并低蛋白血症、凝血功能障碍及肠穿孔数目≥2处可为预后不良提供评估依据。更多还原

【Abstract】 Objective: To explore the clinical features and prognostic evaluation of neonatal necrotizing enterocolitis(NEC)complicated with intestinal perforationand and analyze the risk factors affecting the prognosis. Methods:The clinical data of 93 patients with NEC complicated with intestinal perforation treated by surgery were collected,retrospectively. According to the prognosis of patients,they were divided into good outcome group(69 cases)and poor outcome group(24 cases),and single factor and multivariate Logistic regression were used to analyze the risk factors affecting their prognosis. Results:Most of the 93 children were born prematurely(83.9%)and low-birth weight(80.6%). Patients always accompanied by hypoproteinemia(45.2%)and hypokalemia(39.8%). During the operation,it was found that small bowel perforation(52.7%)and single perforation were more common(79.6%).The patient accompanied by hypoproteinemia(OR=2.077,95% CI:1.931-31.889),coagulation dysfunction(OR=22.829,95% CI:7.063-532.608)and the number of intestinal perforations ≥2(OR=3.209,95% CI:1.623-126.806)were independent risk factors for poor prognosis(all P<0.05). Combining the above independent risk factors to predict poor outcome,the area under the ROC curve was 0.862(95% CI:0.764-0.961),and the specificity and sensitivity were 83.3% and 77.1%,respectively. Conclusion:Children with NEC complicated by intestinal perforation have complex conditions and high incidence of poor outcome. Hypoproteinemia,coagulation dysfunction,and the number of intestinal perforations ≥2 can provide assessment basis for poor prognosis.更多还原