急慢性放射性肠炎32例临床研究

目的 通过对放射性肠炎的临床观察,分析急慢性放射性肠炎的病例特点及治疗效果.方法 对32例放射性肠炎进行回顾性分析,观察其病例特点,比较其治疗效果及预后.结果 23例急性放射性肠炎疗程短、疗效好,治疗有效率达95.6%,预后良好;9例慢性放射性肠炎疗程长,起效时间长,治疗有效率33.3%,预后不良.结论 放射性肠炎以预防为主,急性期治疗效果较好,若为慢性迟发型则治疗困难,预后不佳.     

早产儿坏死性小肠结肠炎临床特点分析

目的　比较早产儿与足月儿坏死性小肠结肠炎 (necrotizingenterocolitis ,NEC)临床特点。　方法　回顾性分析 1994至 2 0 0 3年我所收治的早产NEC患儿 2 8例和足月NEC患儿 3 5例的临床表现、X线表现和实验室检查特点。　结果　早产儿组与足月儿组比较皮肤灰白 5 4% (15 / 2 8)和 2 6% (9/ 3 5 ) ,P <0 .0 5 )、肌张力低下 [4 6% (13 / 2 8)和 14 % (5 / 3 5 ) ,P <0 .0 1]等全身表现明显 ;肠鸣音减弱或消失比足月儿组多见 [5 7% (16/ 2 8)与 2 3 % (8/ 3 5 ) ,P <0 .0 1] ;代谢性酸中毒 [5 4% (15 / 2 8)和 2 3 % (8/ 3 5 ) ,P <0 .0 5 ]和血清尿素氮增高 [3 6% (10 / 2 8)和 14 % (5 / 3 5 ) ,P <0 .0 5 ]比例高。　结论　早产儿NEC病情严重 ,进展迅速 ,应该给予及时正确的处理。并对发病趋势、发病日龄、早期诊断和手术治疗进行了讨论。     

Rate and predictors of 30-day readmission for clostridiodes difficile: a United States analysis

BackgroundClostridiodes difficile is a leading cause of healthcare-associated diarrhea. In this study, we aimed to identify the rates and predictors for 30-day readmissions of Clostridiodes difficile Enterocolitis (CDE) in the United States.MethodsWe conducted a retrospective study of the Nationwide Readmissions Database to identify adult hospitalizations with a principal diagnosis of CDE for 2018. Individuals <18 years old and elective hospitalizations were excluded. Primary outcomes included readmission rate and the top ten principal diagnosis on readmission, while the secondary outcomes were inpatient mortality, hospital costs and independent predictors of 30-day all-cause readmissions. Furthermore, we devised a scoring system to estimate the risk of CDE readmissions. Stata® Version 16 was used for statistical analysis and p-values ≤0.05 were statistically significant.ResultsWe identified 94,668 index hospitalizations and 18,296 readmissions at 30-days for CDE in 2018. The 30-day all-cause readmission rate was 25.7%. On readmission, CDE was the most common principal diagnosis (25.7%), followed by unspecified sepsis, and acute renal failure. A female predominance was also noted for index and 30-day readmissions of CDE. Compared to index admissions, we noted higher odds of inpatient mortality [4.4 vs 1.4%, Odds Ratio (OR):3.32, 95% Confidence Interval (CI):2.87–3.84, p < 0.001], longer mean length of stay (LOS) [6.4 vs 5.6 days, Mean Difference (MD):0.9, 95% CI:0.7–1.0, p < 0.001), and higher mean total hospital charge (THC) [$56,015 vs $40,871, MD:15,144, 95% CI:13,260–17,027, p < 0.001] for 30-day readmissions of CDE. Independent predictors for 30-day all-cause readmissions of CDE included discharged against medical advice (AMA) [Adjusd Hazard Ratio (aHR):2.01, 95% CI:1.73–2.53, p < 0.001], diabetes mellitus (DM) [aHR:1.22, 95% CI:1.16–1.29, p < 0.001], and chronic kidney disease (CKD) [aHR:1.29, 95% CI:1.21–1.37, p < 0.001].ConclusionThe all-cause 30-day readmission rate and inpatient mortality for CDE was 25.7% and 4.4%, respectively. Discharge AMA, DM and CKD were independent predictors for 30-day all-cause readmissions of CDE.

KEY MESSAGE

1. The 30-day all-cause readmission rate for Clostridiodes difficile Enterocolitis was noted to be 21.4% in 2018.
2. Independent predictors of 30-day all-cause readmissions for Clostridiodes difficile Enterocolitis include diabetes mellitus, discharged against medical advice and chronic kidney disease.
3. Readmissions of Clostridiodes difficile Enterocolitis had higher mortality rates, healthcare cost and length of hospital stay compared to index admissions.

     

Non-clostridium difficile induced pseudomembranous colitis

Pseudomembranous colitis is severe inflammation of the inner lining of the colon due to anoxia, ischemia, endothelial damage, and toxin production. The majority of cases of pseudomembranous colitis are due to Clostridium difficile. However,other causative pathogens and agents have been responsible for causing a similar pattern of injury to the bowel with the endoscopic appearance of yellow-white plaques and membranes on the mucosal surface of the colon. Common presenting symptoms and signs inclu...     

全肠道外营养在新生儿坏死性小肠结肠炎中的应用

通过观察新生儿坏死性小肠结肠炎患儿在全肠道外营养前后体重变化,监测其血浆总蛋白和白蛋白、肝功能及ALT、血BUN和血清氨基酸谱,认为全肠外营养在患儿需禁食时能提供较高热卡,保证患儿体重增长和生长发育,促进机体康复。全肠外营养应用了新生儿安全有效,18-氨基酸-600T是新生儿及好发新生儿坏死性小肠结肠炎的低体重儿作全肠外营养的合适配方。     

Sonographic evaluation of neonates with early-stage necrotizing enterocolitis

Background: Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in neonatal intensive care units. Ultrasonographic findings in early-stage NEC have not been described. Objective: To assess the diagnostic value of ultrasonography for the diagnosis and monitoring of patients with NEC. Materials and methods: We evaluated the sonographic findings of early stages of NEC in 40 neonates who were clinically diagnosed with NEC when they were 2–28 days old. Their average gestational age was 32 weeks, and their mean weight was 1,850 g. All of the patients showed signs of bowel distention on abdominal radiography, with no evidence of pneumatosis intestinalis. We performed bowel sonography in all patients (n = 40), as well as in ten healthy neonates who served as a control group. The studies were conducted with a 10-MHz linear transducer from February 2003 to January 2004. We evaluated the echogenicity of the bowel wall, involved region, ascites, and portal venous gas at both initial and follow-up examinations. We divided the patients into two groups according to the bowel wall echogenicity pattern, group I with echogenic dots in the bowel wall and group II with dense granular echogenicities in the bowel wall. In order to identify any correlations between the ultrasonography and clinical findings, we evaluated the duration of parenteral feeding (NPO) in each group and compared two groups by means of a statistical analysis (Mann–Whitney test). Results: All of the neonates in the control group (n = 10) presented normal bowel wall echogenicity; the patients with NEC presented echogenic dots in 16 patients (40%) and dense granular echogenicities in 24 patients (60%). Portal venous gas was absent in all patients. On the follow-up examinations, the echogenicity of the bowel wall and ascites decreased in 37 patients (93%). The duration of NPO was 11.1 ± 6.6 days in group I and 16.5 ± 7.2 days in group II (P < 0.05). Conclusion: Echogenic dots or dense granular echogenicities in the bowel wall can be seen in patients with early-stage NEC. Bowel sonography can be helpful for the early diagnosis and monitoring of patients with NEC.This paper was presented at the RSNA 2003 scientific paper session.     

An approach to minimize postoperative enterocolitis in Hirschsprung's disease

Background/Purpose

Enterocolitis (EC) is a common and severe complication after pull-through for Hirschsprung's disease; its pathogenesis remains unclear, but the role of coexistent intestinal neuronal dysplasia (IND) in the proximal colon may be relevant. This study evaluated the relationship between postoperative EC and IND and assessed whether a surgical protocol including resection of coexistent IND could prevent postoperative EC.

Methods

Between June 1993 and June 2002, 36 patients with aganglionosis were submitted to definitive surgical treatment. There were 2 sequential sets of patients: group I (n = 17), in whom the resection was confined to the aganglionic colon, and group II (n = 19), who were additionally submitted to resection of the coexistent IND segment; excision was restricted to the hepatic flexure in long segmental IND. The prevalence of postoperative EC and anorectal function were evaluated and compared between the 2 groups.

Results

There was no mortality. Fifteen patients had isolated aganglionosis, and 21 presented with aganglionosis plus proximal IND. All 6 children who developed postoperative EC had coexistent IND. In group I, 9 patients had coexistent IND and 5 developed postoperative EC (5/17, 29%). In group II, 12 patients had coexistent IND but only 1 patient, with long segmental IND, developed postoperative EC (1/19, 5%). Among the patients with proximal IND, the prevalence of postoperative EC was 29%; but it was significantly lower in group II than in group I (1/12 or 8% vs 5/9 or 56%; P = .02). Anorectal function was excellent or good in more than 80% of the patients in both groups.

Conclusions

Postoperative EC was associated with retained proximal IND, suggesting that coexisting IND may be, at least, a predictive marker for this complication. Histochemical characterization of the proximal colon with no radical resection of the IND segment seems to be an effective and safe approach to minimize the prevalence of postoperative EC.     

肠细胞凋亡在新生鼠坏死性小肠结肠炎肠损伤中动态变化

目的动态观察新生大鼠坏死性小肠结肠炎(NEC)发病过程中肠细胞凋亡率变化及其与肠损伤关系。方法40只新生SD大鼠随机分成对照组(C)和模型组(M)。对照组8只;模型组32只,在出生48h开始给予鼠配方奶人工喂养,100%氮气缺氧90s,4℃冷刺激10min,每天2次,连续3d,建立新生大鼠NEC模型;模型组开始造模后24h(M24)、48h(M48)、72h(造模结束,M72)及造模结束后24h(M96)分别处死8只,留取肠管进行肠组织损伤评分和肠细胞凋亡率检测(流式细胞仪)。组织学评分≥2确定为NEC。各组随机选取1份回盲部近端小肠标本进行肠黏膜透射电镜检查。采用SPSS11.0统计学软件进行统计分析,α=0.05为显著性检验标准。结果透射电镜显示模型组大鼠肠黏膜出现大量凋亡细胞,形成凋亡小体。对照组、M24、M48、M72和M96肠组织损伤评分分别为(0.08±0.15)、(1.38±0.42)、(1.46±0.69)、(1.58±0.30)分和(3.33±0.59)分,肠细胞凋亡率分别为4.8%±2.9%、12.8%±6.3%、14.9%±5.5%、17.7%±5.5%和27.6%±9.9%。肠损伤程度与肠细胞凋亡率呈显著正相关(r凋亡率=0.853,P<0.01)。结论新生鼠肠细胞凋亡增加是NEC肠组织损伤起始事件;随时间延长,肠细胞凋亡增加程度进一步加重;肠细胞凋亡增加是造成新生鼠NEC肠道进行性损伤的病理基础。