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目的分析新生儿胃肠穿孔的病因、临床特征、治疗及预后。方法回顾性分析2004年1月至2015年12月复旦大学附属儿科医院新生儿科收治的80例新生儿胃肠穿孔患儿的临床资料,根据出生胎龄分为早产儿组与足月儿组,比较两组间的病因、临床表现、治疗及预后。结果 80例新生儿胃肠穿孔中,早产儿62例,足月儿18例。两组病因均以坏死性小肠结肠炎(necrotizing enterocolitis,NEC)为主,临床均以腹胀为主要表现,早产儿发生反应差、休克、弥散性血管内凝血明显多于足月儿(P<0.05)。早产儿组平均发病日龄9(1.75,20)d,足月儿组平均发病日龄4.5(1,7.75)d。62例手术治疗,其中胃穿孔8例,肠穿孔54例,18例因未手术穿孔部位不明确。死亡32例,病死率40%,早产儿死亡26例(病死率41.9%),足月儿死亡6例(病死率33.3%)。结论新生儿胃肠穿孔是新生儿期的严重疾病,病死率高。早期诊断、积极治疗和尽早外科干预可能提高患儿的存活率,显著改善患儿的预后。
Objective To analyze the etiology, clinical features, treatment and prognosis of neonatal gastrointestinal perforation. Methods The clinical data of 80 neonates with gastrointestinal perforation admitted from the Department of Neonatology, Pediatric Hospital of Fudan University from January 2004 to December 2015 were retrospectively analyzed. According to the gestational age at birth, the data were divided into premature infants and full-term infants, Etiology, clinical manifestations, treatment and prognosis were compared between the two groups. Results 80 cases of gastrointestinal perforation of newborns, 62 cases of premature children, full-term children in 18 cases. Necrosis of the two groups were mainly caused by necrotizing enterocolitis (NEC), with abdominal distension as the main clinical manifestations, poor response in preterm infants, and more shock and disseminated intravascular coagulation than those in term infants (P <0.05) ). The mean age of onset of preterm infants was 9 (1.75, 20) d, and the full-term infants were 4.5 (1.75) days. Sixty-two cases were surgically treated, including 8 cases of gastric perforation, 54 cases of intestinal perforation and 18 cases of non-operative perforation site. Thirty-two deaths were reported, with a case fatality rate of 40%, 26 premature infants (a mortality rate of 41.9%) and 6 full-term infants (a case fatality rate of 33.3%). Conclusion Neonatal gastrointestinal perforation is a serious disease in neonatal period, with high mortality rate. Early diagnosis, aggressive treatment and early surgical intervention may improve the survival rate of children, significantly improve the prognosis of children.