新生儿坏死性小肠结肠炎发生的危险因素研究
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摘要
目的:研究新生儿坏死性小肠结肠炎(NEC)发生的危险因素。方法 :采用回顾性分析法,收集NEC治疗的新生儿临床资料358例,并随机抽取同期在我院住院治疗的非NEC患儿342例,NEC组设为观察组,非NEC组设为对照组。收集患儿的围产期资料及合并疾病进行单因素分析,围产期资料包括分娩方式、早产、母妊娠高血压、母妊娠期糖尿病、母孕期使用地塞米松、胎盘早破、呼吸窘迫综合征、低体重儿、羊水异常、出生窒息、喂养方式。合并疾病包括先天性心脏病、感染肺炎、呼吸窘迫综合征、肺出血、消化道出血、低血糖症、电解质紊乱、败血症、高胆红素血症、胆汁淤积症。随后选取可能会对NEC产生影响的因素进行多因素Logistics分析。结果 :观察组患儿病死率(15.08%)明显高于对照组患儿(3.21%)(P<0.05)。低体重儿、出生窒息、母乳喂养和早产儿中对照组和观察组差异有统计学意义(P<0.05);剖宫产、母妊娠高血压、母妊娠糖尿病、母孕期使用地塞米松、羊水异常和胎膜早破两组之间差异没有统计学意义(P>0.05)。两组患儿中败血症和高胆红素血症的发生率有差异有统计学意义(P<0.05);先天性心脏病、感染性肺病、呼吸窘迫综合征、低血糖、肺出血、电解质紊乱、消化道出血和胆汁淤积症发生率两组患者均差异没有统计学意义(P>0.05)。将进行单因素分析后显示有统计学差异的变量纳入NEC发生的多因素Logistics分析显示,低体重儿、出生窒息、早产儿、败血症、高胆红素血症为NEC发病的主要危险因素,母乳喂养为NEC发病的保护性因素。结论:低体重儿、出生窒息、早产儿、败血症和喂养方式均为NEC发生的独立危险因素,高胆红素症对NEC发生的影响还需进一步研究。
Objective:Purpose The risk factors for neonatal necrotizing enterocolitis were studied in this paper.Methods:A retrospective analysis was used to collect data on 358 neonates undergoing NEC treatment,we randomly selected 342 non-NEC patients hospitalized in our hospital during the same period.The NEC group was used as the observation group,and the non-NEC group was set as the control group.Perinatal data and comorbidities were collected for univariate analysis.Perinatal data included delivery,premature delivery,maternal gestational hypertension,maternal gestational diabetes,dexamethasone during pregnancy,premature rupture of placenta,respiratory distress syndrome,low birth weight,abnormal amniotic fluid,birth asphyxia,feeding methods.Subsequently,multivariate Logistics analysis was performed to select factors that may affect NEC.Results:The mortality rate in the observation group(15.08%)was significantly higher than that in the control group(3.21%)(P<0.05).There was a significant difference between the control group and the observation group in low birth weight,birth asphyxia,breastfeeding and preterm infants(P<0.05).There was no significant difference between cesarean section,maternal gestational hypertension,maternal gestational diabetes,dexamethasone during pregnancy,amniotic fluid abnormalities and premature rupture of membranes(P>0.05).There was a significant difference in the incidence of sepsis and hyperbilirubinemia between the two groups(P<0.05).There was no significant difference in the incidence of congenital heart disease,infectious lung disease,respiratory distress syndrome,hypoglycemia,pulmonary hemorrhage,electrolyte imbalance,gastrointestinal hemorrhage and cholecytosis(P >0.05).Multivariate logistics analysis showed that low birth weight infants,birth asphyxia,premature infants,sepsis,and hyperbilirubinemia were the main risk factors for the development of NEC,feeding is a protective factor for the onset of NEC.Conclusion:Low birth weight infants,birth asphyxia,premature infants,sepsis and feeding methods are all independent riskfactors for NEC.The effects of hyperbilirubinemia on NEC need further study.
Objective:Purpose The risk factors for neonatal necrotizing enterocolitis were studied in this paper.Methods:A retrospective analysis was used to collect data on 358 neonates undergoing NEC treatment,we randomly selected 342 non-NEC patients hospitalized in our hospital during the same period.The NEC group was used as the observation group,and the non-NEC group was set as the control group.Perinatal data and comorbidities were collected for univariate analysis.Perinatal data included delivery,premature delivery,maternal gestational hypertension,maternal gestational diabetes,dexamethasone during pregnancy,premature rupture of placenta,respiratory distress syndrome,low birth weight,abnormal amniotic fluid,birth asphyxia,feeding methods.Subsequently,multivariate Logistics analysis was performed to select factors that may affect NEC.Results:The mortality rate in the observation group(15.08%)was significantly higher than that in the control group(3.21%)(P<0.05).There was a significant difference between the control group and the observation group in low birth weight,birth asphyxia,breastfeeding and preterm infants(P<0.05).There was no significant difference between cesarean section,maternal gestational hypertension,maternal gestational diabetes,dexamethasone during pregnancy,amniotic fluid abnormalities and premature rupture of membranes(P>0.05).There was a significant difference in the incidence of sepsis and hyperbilirubinemia between the two groups(P<0.05).There was no significant difference in the incidence of congenital heart disease,infectious lung disease,respiratory distress syndrome,hypoglycemia,pulmonary hemorrhage,electrolyte imbalance,gastrointestinal hemorrhage and cholecytosis(P >0.05).Multivariate logistics analysis showed that low birth weight infants,birth asphyxia,premature infants,sepsis,and hyperbilirubinemia were the main risk factors for the development of NEC,feeding is a protective factor for the onset of NEC.Conclusion:Low birth weight infants,birth asphyxia,premature infants,sepsis and feeding methods are all independent riskfactors for NEC.The effects of hyperbilirubinemia on NEC need further study.
引文
[1]郭城,张琳.益生菌在新生儿坏死性小肠结肠炎中的应用[J].中国实用儿科杂志,2017,32(2):120-125.
[2]丁晓燕.早期预防性应用益生菌对低出生体重儿坏死性小肠结肠炎影响研究[J].陕西医学杂志,2017,46(9):1178-1179.
[3]黄国盛.早产儿坏死性小肠结肠炎危险因素及预防[J].广西医科大学学报,2013,30(2):290-292.
[4]曾德峰,谭忠友.新生儿坏死性小肠结肠炎的高危因素及外科治疗预后影响因素的研究[J].重庆医科大学学报,2017,42(3):361-364.
[5]曹立园.64例足月新生儿坏死性小肠结肠炎高危因素临床分析[D].吉林大学,2015.
[6]李燕,潘新年.新生儿坏死性小肠结肠炎临床防治新进展[J].中国新生儿科杂志,2016,31(6):473-476.
[7]晏俪鸶.新生儿坏死性小肠结肠炎发病原因及预后研究进展[J].国际儿科学杂志,2016,43(6):470-473.
[8]贺锐,张丽秀,叶萍,等.低出生体重儿肠道菌群及肠道屏障功能的研究[J].中国微生态学杂志,2017,29(9):1022-1026.
[9]孔祥永,封志纯.肠道微生态与新生儿坏死性小肠结肠炎关系研究进展[J].中国新生儿科杂志,2011,26(02):133-135.
[10]郭婧,梁东梅,周露露,等.新生儿坏死性小肠结肠炎预防的研究进展[J].医学综述,2016,22(18):3618-3621.
[11]刘利,李秋宇,安瑶,等.早产与足月新生儿坏死性小肠结肠炎临床对比分析[J].重庆医科大学学报,2017(8):1006-1010.
[12]张敕.低/极低体重儿“积极”的营养支持对NEC、晚发型败血症的影响分析[J].陕西医学杂志,2016,45(12):1609-1610.
[13]戴秋曦.新生儿坏死性小肠结肠炎发病机制及诊治研究进展[J].国际儿科学杂志,2017,44(1):6-9.
[2]丁晓燕.早期预防性应用益生菌对低出生体重儿坏死性小肠结肠炎影响研究[J].陕西医学杂志,2017,46(9):1178-1179.
[3]黄国盛.早产儿坏死性小肠结肠炎危险因素及预防[J].广西医科大学学报,2013,30(2):290-292.
[4]曾德峰,谭忠友.新生儿坏死性小肠结肠炎的高危因素及外科治疗预后影响因素的研究[J].重庆医科大学学报,2017,42(3):361-364.
[5]曹立园.64例足月新生儿坏死性小肠结肠炎高危因素临床分析[D].吉林大学,2015.
[6]李燕,潘新年.新生儿坏死性小肠结肠炎临床防治新进展[J].中国新生儿科杂志,2016,31(6):473-476.
[7]晏俪鸶.新生儿坏死性小肠结肠炎发病原因及预后研究进展[J].国际儿科学杂志,2016,43(6):470-473.
[8]贺锐,张丽秀,叶萍,等.低出生体重儿肠道菌群及肠道屏障功能的研究[J].中国微生态学杂志,2017,29(9):1022-1026.
[9]孔祥永,封志纯.肠道微生态与新生儿坏死性小肠结肠炎关系研究进展[J].中国新生儿科杂志,2011,26(02):133-135.
[10]郭婧,梁东梅,周露露,等.新生儿坏死性小肠结肠炎预防的研究进展[J].医学综述,2016,22(18):3618-3621.
[11]刘利,李秋宇,安瑶,等.早产与足月新生儿坏死性小肠结肠炎临床对比分析[J].重庆医科大学学报,2017(8):1006-1010.
[12]张敕.低/极低体重儿“积极”的营养支持对NEC、晚发型败血症的影响分析[J].陕西医学杂志,2016,45(12):1609-1610.
[13]戴秋曦.新生儿坏死性小肠结肠炎发病机制及诊治研究进展[J].国际儿科学杂志,2017,44(1):6-9.