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早产儿坏死性小肠结肠炎临床特点及肠道病原学分析

卢燕 潘珊珊

卢燕, 潘珊珊. 早产儿坏死性小肠结肠炎临床特点及肠道病原学分析[J]. 中华全科医学, 2022, 20(8): 1357-1359. doi: 10.16766/j.cnki.issn.1674-4152.002596
引用本文: 卢燕, 潘珊珊. 早产儿坏死性小肠结肠炎临床特点及肠道病原学分析[J]. 中华全科医学, 2022, 20(8): 1357-1359. doi: 10.16766/j.cnki.issn.1674-4152.002596
LU Yan, PAN Shan-shan. Analysis of the clinical characteristics and stool pathogen of necrotising enterocolitis in preterm neonates[J]. Chinese Journal of General Practice, 2022, 20(8): 1357-1359. doi: 10.16766/j.cnki.issn.1674-4152.002596
Citation: LU Yan, PAN Shan-shan. Analysis of the clinical characteristics and stool pathogen of necrotising enterocolitis in preterm neonates[J]. Chinese Journal of General Practice, 2022, 20(8): 1357-1359. doi: 10.16766/j.cnki.issn.1674-4152.002596

早产儿坏死性小肠结肠炎临床特点及肠道病原学分析

doi: 10.16766/j.cnki.issn.1674-4152.002596
基金项目: 

浙江省医药卫生科技项目 2021PY057

详细信息
    通讯作者:

    潘珊珊, E-mail: Pss_2005@163.com

  • 中图分类号: R574.5 R574.62 R722.6

Analysis of the clinical characteristics and stool pathogen of necrotising enterocolitis in preterm neonates

  • 摘要:   目的  分析早产儿坏死性小肠结肠炎(NEC)的临床特征。  方法  收集2017年1月—2020年11月在杭州市第一人民医院新生儿科住院符合Bell诊断标准的59例NEC患儿的临床资料并进行回顾性分析。  结果  59例NEC患儿中Ⅰ期22例(37.3%),Ⅱ期或Ⅲ期37例(62.7%)。NEC患儿发病日龄为生后14.0(13.0, 18.0) d,胎龄为(30.7±2.7)周,出生体重为(1 493.9±460.3)g。男36例(61.0%),女23例(39.0%)。NEC患儿发病后临床表现为血便(79.7%,47/59)、胃内潴留(78.0%、46/59)、肠鸣音减弱(57.6%,34/59)、腹胀(52.5%,31/59)。Ⅱ期及以上NEC患儿腹胀、反应差、肠鸣音减弱、心动过速,CRP≥50 mg/L,白细胞 < 4×109/L发生率更高,差异有统计学意义(均P < 0.05)。大便培养阳性率为65.5%(36/55),主要包括肺炎克雷伯菌(29.1%,16/55)、屎肠球菌(20.0%,11/55)、大肠埃希菌(12.7%,7/55)。血培养阳性率为15.1%(8/53),主要包括大肠埃希菌(3.8%,2/53)、肺炎克雷伯菌(3.8%,2/53)。NEC手术治疗比例为20.3%(12/59),病死率为16.9%(10/59)。  结论  早产儿NEC以胎龄28~32周,出生体重1 000~1 950 g为主。NEC患儿胃肠道症状突出,NEC Ⅰ期和Ⅱ期或以上患儿临床表现及实验室检查方面均有显著不同。NEC患儿粪便培养阳性率高,肠道致病菌监测有助于指导临床治疗。

     

  • 表  1  不同分期NEC患儿一般情况比较

    Table  1.   Comparison of general condition of children with NEC at different stages

    组别 例数 男/女(例) 胎龄
    (x±s,周)
    出生体重
    (x±s,g)
    分娩方式[例(%)] 喂养方式[例(%)] 发病日龄
    [(M(P25, P75),d)]
    顺产 剖宫产 母乳 配方奶
    Ⅰ期 22 14/8 31.1±3.2 1 522.5±442.2 7(31.8) 15(68.2) 5(22.7) 17(77.3) 14.5(11.5,18.3)
    Ⅱ期或Ⅲ期 37 22/15 30.4±2.4 1 476.9±475.9 7(18.9) 30(81.1) 9(24.3) 28(75.7) 14.0(13.0,18.5)
    统计量 0.101a 0.907b 0.365b 1.268a 0.019a -0.409c
    P 0.750 0.368 0.716 0.260 0.889 0.682
    注:a为χ2值,bt值,cZ值。
    下载: 导出CSV

    表  2  不同分期NEC患儿临床表现比较[例(%)]

    Table  2.   Comparison of clinical manifestations in children with different stages of NEC [cases (%)]

    组别 例数 腹胀 发热 反应差 胃内潴留 血便 肠鸣音减弱 呼吸暂停 心动过速
    Ⅰ期 22 5(22.7) 1(4.5) 4(18.2) 16(72.7) 20(90.9) 6(27.3) 5(22.7) 4(18.2)
    Ⅱ期或Ⅲ期 37 26(70.3) 4(10.8) 23(62.2) 30(81.1) 27(73.0) 28(75.7) 13(35.1) 17(45.9)
    χ2 12.506 10.752 13.237 1.002 4.639
    P < 0.001 0.642a 0.001 0.524a 0.179a < 0.001 0.317 0.031
    注:a为采用Fisher精确检验。
    下载: 导出CSV

    表  3  不同分期NEC患儿实验室检查结果比较[例(%)]

    Table  3.   Comparison of laboratory results in children with different stages of NEC [cases (%)]

    组别 例数 CRP(mg/L) 白细胞数(×109/L) 血小板(×109/L)
    < 50 ≥50 ≥4 < 4 ≥100 < 100
    Ⅰ期 22 17(77.3) 5(22.7) 20(90.9) 2(9.1) 20(90.9) 2(9.1)
    Ⅱ期或Ⅲ期 37 11(29.7) 26(70.3) 17(45.9) 20(54.1) 26(70.3) 11(29.7)
    χ2 12.506 11.928 2.325
    P < 0.001 0.001 0.127
    下载: 导出CSV
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  • 收稿日期:  2021-01-17

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