新生儿坏死性小肠结肠炎伴发败血症的危险因素研究

Risk factors for concurrent sepsis in neonates with necrotizing enterocolitis

摘要:

目的 探讨新生儿坏死性小肠结肠炎 （NEC） 伴发败血症的危险因素。方法 回顾性研究273例NEC患儿的临床资料，分析伴发败血症的危险因素。结果 NEC伴发败血症的几率为32.2% （88/273）。Ⅲ期NEC伴发败血症的几率高于Ⅱ期 （69.0% vs 15.9%，P < 0.05）。62.5%的败血症发生在NEC诊断后3d内，37.5%发生在3d后。伴发败血症的NEC患儿与未伴发者相比，出生胎龄更小，出生体重更低 （P < 0.05）。硬肿症 （OR：9.75，95% CI：2.84~33.52，P < 0.001）、Ⅲ期NEC （OR：12.94，95% CI：6.82~24.55，P < 0.001） 及胃肠减压 （OR：2.27，95% CI：1.14~4.5，P=0.02） 为NEC伴发败血症的独立危险因素。结论 硬肿症、Ⅲ期NEC及胃肠减压为NEC伴发败血症的独立危险因素。

Abstract:

Objective To investigate the risk factors for concurrent sepsis in neonates with necrotizing enterocolitis (NEC). Methods A retrospective analysis was performed for the clinical data of 273 neonates with NEC. The risk factors for concurrent sepsis were analyzed from the aspects of perinatal factors and treatment regimen before the diagnosis of NEC. Results The incidence rate of concurrent sepsis in NEC was 32.2% (88/273). The neonates with stage Ⅲ NEC had a significantly higher incidence rate of concurrent sepsis than those with stage Ⅱ NEC (69.0% vs 15.9%; P < 0.05). Of all neonates with sepsis, 62.5% experienced sepsis within 3 days after the diagnosis of NEC, and 37.5% experienced sepsis more than 3 days after the diagnosis. Compared with those without concurrent sepsis, the neonates with concurrent sepsis had significantly lower gestational age and birth weight (P < 0.05). The neonates who had scleredema, had stage Ⅲ NEC, needed gastrointestinal decompression after the diagnosis of NEC, and experienced a long time of gastrointestinal decompression tended to develop sepsis more easily (P < 0.05). Scleredema (OR=9.75, 95%CI:2.84-33.52, P < 0.001), stage Ⅲ NEC (OR=12.94, 95%CI:6.82-24.55, P < 0.001), and gastrointestinal decompression (OR=2.27, 95%CI:1.14-4.5, P=0.02) were independent risk factors for concurrent sepsis in NEC. Conclusions Scleredema, stage Ⅲ NEC, and gastrointestinal decompression are independent risk factors for concurrent sepsis in neonates with NEC.