早期新生儿腹胀临床分析

Clinical characteristics of abdominal distention in early newborns

摘要:

目的 腹胀是新生儿患者常见症状，严重时可危及生命，因此应尽快明确腹胀原因，避免严重后果。该文旨在探讨早期新生儿腹胀的临床特点，为临床医生对腹胀的病因诊断和鉴别诊断提供帮助。方法 回顾性分析2011年1月至2012年12月有腹胀主诉和临床表现的201例早期新生儿临床特点，其中早产儿65例，足月儿136例。结果 先天畸形（包括先天性巨结肠、肛门闭锁、肠旋转不良、肠闭锁、肠重复畸形、后尿道瓣膜）为早期新生儿腹胀的主要病因，分别为早产组44.6%、足月组61.8%。就单病种而言，败血症为早产组第1位及足月组第2位病因，分别为35.4%和21.3%；先天性巨结肠为足月组第1位及早产组第2位病因，分别为33.8%和13.8%。呕吐为腹胀的主要伴随症状，在足月组占64.0%，早产组占44.6%。早产组以肠胀气可见液平为第1位X线表现，占47.7%，足月组占30.1%。足月组以肠胀气为第1位X线表现，占57.3%，早产组占40%。对因及对症治疗后，早产组86.2%、足月组88.2%的患儿以治愈或好转为转归，组间差异无统计学意义。结论 先天畸形为腹胀早期新生儿主要病因；就单病因而言，败血症和先天性巨结肠分别为早期早产儿和早期足月儿的第1位病因；呕吐是早期新生儿腹胀的主要伴随症状；早期早产儿X线表现较足月儿严重；两组患儿转归均较好。

Abstract:

Objective Abdominal distention is a common disorder in newborns, which can be life-threatening in severe cases. Currently, little literature is available regarding early identification of the etiology of this disorder in newborn babies, which is imperative to reducing the likelihood of serious consequences. This retrospective study was conducted to analyze the clinical characteristics of early newborns with abdominal distention, aiming at identifying the underlying etiologic factors. Methods Medical records of 201 (65 premature and 136 full-term) early newborns with abdominal distention between January 2011 and December 2012 were retrieved. Results Congenital malformations (including congenital megacolon, anal atresia, malrotation, intestinal atresia, intestinal duplication and posterior urethral valves) occurred in 44.6% of the premature newborns with abdominal distention and 61.8% of the full-term newborns with the disorder. Congenital megacolon was the number one cause of abdominal distention in the full-term group (33.8%) and the number two cause in the preterm group (13.8%). As far as other individual abnormalities were concerned, sepsis was the number one cause of abdominal distention in the preterm group (35.4%) and the number two cause in the full-term group (21.3%). Vomiting was a main symptom associated with abdominal distension, occurring in 64.0% of the full-term newborns and 44.6% of the preterm newborns. The most pronounced X-ray manifestation was bowel distention with an air-fluid level in the preterm group (47.7%) but was bowel distention without a fluid level in the full-term group (57.3%). Eliological and symptomatic treatment was effective in 86.2% of the premature cases and 88.2% in the full-term cases (P >0.05). Conclusions Congenital malformations may be the major cause of abdominal distension in early newborns. Sepsis and congenital megacolon are the single disease most frequently associated with abdominal distention in preterm and full-term newborns respectively. Vomiting is a main accompanying symptom in early newborns with abdominal distention. X-ray manifestations seem to be more severe in preterm newborns than in full term newborns. A satisfactory outcome can be achieved after treatment in both preterm and full-term newborns with this disorder.