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【目的】探讨早产儿消化道穿孔早期临床诊断,为早治疗提供依据。【方法】总结本院近5年共10例早产儿消化道穿孔的一般情况,发病时间及早期临床表现特点、诊断方法、预后,分析穿孔的可能促发因素。【结果】1)10例患儿,男女比例为3∶2,平均胎龄32周,平均体重1 555g,其中小于胎龄儿(small for gestational age,SGA)5例,双胎7/10;2)发病时间平均为生后26h(9～70h)。以呕吐、腹胀为首发症状,出现典型临床表现时间平均为生后48h(18～96h)。典型临床表现包括腹胀、张力高、腹壁发青,肠音消失。腹部立位X片显示膈下可见大量游离气体,肝界下移,部分病例腹腔穿刺。2例术后良好,7例死亡,死亡率7/9。1例失访;3)促发因素:感染继发消化道穿孔2例(2/10);自发性消化道穿孔8例(8/10),穿孔后继发感染者6例(6/8)。6例首发症状出现前按时开奶。消化道穿孔前无创呼吸机治疗共5例(5/10)。【结论】小胎龄、低出生体重是发生消化道穿孔高危因素;生后1～2d、重症感染是穿孔发生的高危时间;呕吐和/或腹胀为常见的首发症状;早产儿消化道先天发育薄弱是基础,感染、喂养及无创通气可能为促发因素。出现上述情况临床警惕消化道穿孔。
【Objective】 To investigate the early clinical diagnosis of gastrointestinal perforation in premature infants and provide the basis for early treatment. 【Methods】 The general situation, the onset time, early clinical features, diagnosis and prognosis of 10 cases of preterm infants with gastrointestinal perforation were summarized in our hospital in the past 5 years. The possible causes of perforation were analyzed. 【Results】 1) There were 10 children, the ratio of male to female was 3: 2, average gestational age was 32 weeks and average body weight was 1 555g, of which 5 were smaller than gestational age (SGA) and 7/10 were twins; 2) The average onset time after birth 26h (9 ~ 70h). To vomiting, abdominal distension as the first symptom, a typical clinical manifestations of time after the average 48h (18 ~ 96h). Typical clinical manifestations include bloating, high tension, abdominal wall blue, intestinal sound disappeared. Abdominal Li X-ray showed a lot of free gas shows under the diaphragm, the liver sector down, some cases of abdominal puncture. 2 cases were in good condition, 7 died, the death rate was 7 / 9.1 cases were lost to follow-up. 3) The predisposing factors: 2 cases of secondary perforation of infection (2/10), 8 cases of spontaneous digestive tract perforation / 10), 6 cases of secondary infection after perforation (6/8). 6 cases of first symptom onset before the milk. A total of 5 patients were treated with non-invasive ventilator before perforation (5/10). 【Conclusion】 Small gestational age and low birth weight are the risk factors of gastrointestinal perforation. Serious infection is the high risk time of perforation 1 ~ 2 days after birth. Vomiting and / or bloating are the common first symptoms. Prenatal development of digestive tract Weakness is the basis, infection, feeding and noninvasive ventilation may be pro-developmental factors. Clinical emergence of the above situation alert gastrointestinal perforation.