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目的分析与新生儿坏死性小肠结肠炎(NEC)预后不良有关的因素,为改善NEC的预后提供理论依据。方法对1995年4月至2006年4月我院收治的63例新生儿NEC患儿进行回顾性分析,根据转归不同分为治愈组和预后不良组,比较两组可能与预后相关因素的差异,寻找与预后不良有关的因素,再将单因素分析的结果代入Logistic回归方程进行多因素分析,找出与新生儿NEC预后有关的危险因素。结果63例NEC患儿中根据Bell分期,Ⅰ期38例,Ⅱ期10例,Ⅲ期15例,治愈50例,死亡10例,病死率15.9%,死亡病例均为Ⅲ期患儿,加放弃3例,Ⅲ期预后不良率86.7%。按转归不同分为治愈组50例,预后不良组13例,将两组预后有关因素进行单因素分析发现,早产、呼吸暂停、腹膜炎、休克、DIC、硬肿症、高血糖症、低钠血症、代谢性酸中毒、血小板减少、白细胞异常、腹部X线明显异常、肠穿孔两组差异有统计学意义(P<0.05),提示上述因素与新生儿NEC预后有关。把上述13个单因素进一步做多因素回归分析发现休克、代谢性酸中毒、硬肿症是与NEC预后不良关系最为密切的因素。经分析两组差异有统计学意义(P<0.05)。结论新生儿NEC并发休克、硬肿症、代谢性酸中毒是影响预后的主要危险因素;积极防治NEC的合并症,有助于降低病死率,改善预后。
Objective To analyze the factors related to poor prognosis of neonatal necrotizing enterocolitis (NEC) and provide a theoretical basis for improving the prognosis of NEC. Methods From April 1995 to April 2006, 63 neonates with NEC admitted to our hospital were retrospectively analyzed. According to the different prognosis, the patients were divided into two groups: the cured group and the poor prognosis group. The differences between the two groups in the prognosis-related factors , Looking for the factors associated with poor prognosis, then the results of univariate analysis into the Logistic regression equation for multivariate analysis to identify neonatal NEC prognosis-related risk factors. Results According to Bell staging, there were 38 cases of stage Ⅰ, 10 cases of stage Ⅱ and 15 cases of stage Ⅲ in 63 cases of NEC. Fifty cases were cured and 10 cases died. The death rate was 15.9% 3 cases, stage Ⅲ prognosis poor rate of 86.7%. According to the different outcomes, there were 50 cases in the cured group and 13 cases in the poor prognosis group. Univariate analysis showed that preterm birth, apnea, peritonitis, shock, DIC, scleredema, hyperglycemia, Hyperlipidemia, metabolic acidosis, thrombocytopenia, abnormal white blood cells, abnormal abdominal X-ray and intestinal perforation had statistical significance (P <0.05), suggesting that the above factors were related to the prognosis of neonatal NEC. The above-mentioned 13 single-factor further multi-factor regression analysis found that shock, metabolic acidosis, scleredema and NEC prognosis is the most closely related factors. After analysis, the difference between the two groups was statistically significant (P <0.05). Conclusion Neonatal NEC complicated with shock, scleredema and metabolic acidosis are the main risk factors affecting prognosis. Active prevention and treatment of NEC complications can reduce mortality and improve prognosis.