早产儿消化道穿孔的病因及影响预后的危险因素分析

目的:探讨早产儿消化道穿孔的病因，分析影响早产儿消化道穿孔短期预后不良的危险因素。方法:回顾性分析山西省儿童医院新生儿外科2015年1月—2021 年5月诊治的89 例早产儿消化道穿孔的临床资料。根据术后3 个月时结局分为生存组和预后不良组。比较两组术前、术中及术后与早产儿消化道穿孔预后不良相关的因素，采用Logistic 回归分析筛选早产儿消化道穿孔预后不良的危险因素。结果:早产儿消化道穿孔的病死率为25.84%，坏死性小肠结肠炎（NEC）和胃壁肌层缺损是早产儿消化道穿孔常见的病因。单因素分析显示生存组患儿从发现气腹至手术时间在8 h 之内的比例显著高于预后不良组（χ2=15.22，P＜0.01）。预后不良组合并脓毒性休克的比例显著高于生存组（χ2=33.19，P＜0.01）。预后不良组术后合并需非计划二次手术的并发症比例显著高于生存组（χ2=7.24，P＜0.01）。Logistic 回归分析显示脓毒性休克（OR=0.06，95%CI:0.02~0.21，P＜0.01）和气腹至手术时间大于8 h（OR=0.23，95%CI:0.07~0.81，P＜0.05）是早产儿消化道穿孔短期预后不良的危险因素。结论:NEC 和胃壁肌层缺损是早产儿消化道穿孔的主要病因，脓毒性休克和从气腹发生至手术时间大于8 h 是早产儿消化道穿孔短期预后不良的危险因素。

Etiology and prognostic risk factors of gastrointestinal perforation in preterm neonates

Objective:To investigate the etiology of gastrointestinal perforation in preterm neonates and to explore the risk factors for poorshort-term prognosis. Methods: The clinical data of 89 cases of gastrointestinal perforation in preterm neonates treated in Children'sHospital of Shanxi Province from January 2015 to May 2021 were analyzed retrospectively. They were divided into survival group and poorprognosis group according to the outcome at 3 months postoperation. The factors may be related to the poor prognosis of gastrointestinalperforation in preterm neonates before，during and after operation were compared between the two groups. Logistic regression analysis wasused to screen the risk factors of poor prognosis of gastrointestinal perforation in preterm neonates. Results: The mortality of gastrointestinalperforation in preterm neonates was 25.84%. Necrotizing enterocolitis（NEC）and congenital defects of gastric musculature were majorcauses of gastrointestinal perforation in preterm neonates. Univariate analysis showed that the proportion of patients operated within 8 hoursafter the discovery of pneumoperitoneum in survival group was significantly higher than that in poor prognosis group （χ2=15.22，P＜0.01）.The proportion of septic shock in the poor prognosis group was significantly higher than survival group（χ2=33.19，P＜0.01）. The incidenceof complications requiring unplanned secondary operation was higher in the poor prognosis group than that in the survival group（χ2=7.24，P＜0.01）. Logistic regression analysis showed that septic shock（OR=0.06，95%CI:0.02-0.21，P＜0.01）andmore than 8 hours frompneumoperitoneum to operation（OR=0.23，95%CI:0.07-0.81，P＜0.05）were risk factors for poor short-term prognosis of gastrointestinalperforation in preterm neonates. Conclusion: NEC and congenital defects of gastric musculature are common causes of gastrointestinalperforation in premature neonates. Septic shock and more than 8 hours from pneumoperitoneum to operation are risk factors for poor shorttermprognosis of gastrointestinal perforation in premature neonates.