中国实用儿科杂志

中国实用儿科杂志 ›› 2025, Vol. 40 ›› Issue (5): 401-406.DOI: 10.19538/j.ek20250506011

• 论著 • 上一篇    下一篇

手术治疗坏死性小肠结肠炎新生儿死亡危险因素分析

  

  1. 1.苏州大学附属儿童医院新生儿科，江苏  苏州  215025；2.张家港市第一人民医院新生儿科，江苏  苏州  215600
  • 出版日期:2025-05-06 发布日期:2025-08-28
  • 通讯作者: 朱雪萍，电子信箱：zhuxueping4637@hotmail.com
  • 基金资助:
    国家自然科学基金（82271741）；江苏省卫生健康委员会医学科研课题重点项目（ZD2021013）；姑苏卫生领军人才项目（GSWS2022055）；苏州大学临床科技高端平台和转化基地建设项目（ML13101523）；张家港市卫生青年科技计划项目（ZJGQNKJ202416）

Analysis of risk factors for death in surgical treatment for neonatal necrotizing enterocolitis

  1. *Department of Neonatology，Children's Hospital of Soochow Uinversity，Suzhou  215025，China
  • Online:2025-05-06 Published:2025-08-28

摘要： 目的    回顾性分析手术治疗的坏死性小肠结肠炎（necrotizing enterocolitis，NEC）新生儿临床资料及近期结局，探讨NEC患儿死亡的高危因素，以期早期干预、改善患儿预后。方法    选取2014年1月1日至2022年12月31日收治于苏州大学附属儿童医院新生儿科诊断为NEC且进行手术治疗的新生儿为研究对象，按住院期间结局分为存活组和死亡组，收集两组患儿一般资料、基础病及并发症、发病当天辅助检查及住院期间治疗情况等，通过对比上述资料，分析NEC手术新生儿发生死亡的高危因素。结果    共纳入104例NEC手术新生儿，男56例、女48例，其中存活80例（76.92%），死亡24例（23.08%）；死亡组患儿胎龄、出生体重、发病时纠正胎龄、预后营养指数（PNI）低于存活组（P<0.05），发病至手术时间显著长于存活组，合并败血症、休克、腹胀、腹膜炎、白细胞<4×109/L、血小板计数<50×109/L、pH<7.35、多处穿孔及回结肠同时坏死的发生率显著高于存活组（P<0.05）；死亡组较存活组C-反应蛋白/白蛋白的比值（CAR）、中性粒细胞/淋巴细胞比值（NLR）、乳酸及Duke腹部X线评分（DAAS）明显升高，差异有统计学意义（P<0.05）。多因素Logistic回归分析发现，血小板、CAR、穿孔情况、坏死情况是引起NEC手术新生儿死亡的危险因素。结论    血小板、CAR、穿孔情况、坏死情况是引起NEC手术新生儿死亡的危险因素。

关键词: 坏死性小肠结肠炎, 手术, 死亡, 危险因素

Abstract: Objective    To retrospectively analyze the clinical data and recent outcomes of neonates with necrotizing enterocolitis（NEC）undergoing surgical treatment，and to explore the high-risk factors for mortality in NEC patients，in order to achieve early intervention and improve their prognosis. Methods    Neonates diagnosed with NEC and undergoing surgical treatment at the Neonatology Department of the Children's Hospital of Soochow University from January 1，2014 to December 31，2022 were selected as the study subjects.They were divided into a survival group and a death group according to their hospitalization outcomes.The data concerning general information，underlying diseases and complications，auxiliary examinations on the day of onset，and treatment during hospitalization were collected from the two groups. By comparing the above data，the high-risk factors for death of neonates receiving NEC surgery were analyzed. Results    A total of 104 newborns who underwent NEC surgery were included，including 56 males and 48 females.Among them，80 survived（76.92%）and 24 died（23.08%）. The death group was significantly lower than the survival group in terms of gestational age，birth weight，corrected gestational age at onset，and prognostic nutritional index（PNI）（P<0.05）. The time from onset of disease to operation was significantly longer in the death group than in the survival group（P<0.05）. The incidence of sepsis，shock，abdominal distension，peritonitis，white blood cell count<4×109/L，platelet count<50×109/L，pH<7.35，multiple perforation，and simultaneous necrosis of the ileocolon in the death group was significantly higher than that in the survival group （P<0.05）. The death group had significantly higher levels of C-reactive protein（CRP）/albumin（ALB）ratio（CAR），neutrophil to lymphocyte ratio（NLR），lactate，and Duke abdominal X-ray score（DAAS）compared to the survival group，the difference being of statistical significance（P<0.05）. Multiple Logistic regression analysis showed that platelet count<50×109/L，elevated CAR，multiple perforation，and simultaneous necrosis of the ileocolon are risk factors for neonatal mortality in NEC surgery. Conclusion    A platelet count<50×109/L，elevated CAR，multiple perforation，and simultaneous necrosis of the ileocolon are risk factors for neonatal mortality in NEC surgery.

Key words: necrotizing enterocolitis, surgery, death, risk factors