西藏高原地区新生儿坏死性小肠结肠炎48例分析

目的 分析西藏高原地区新生儿坏死性小肠结肠炎(NEC)的临床表现、治疗方法及转归,以提高临床医师对该病的诊治及预防水平。 方法 调阅西藏山南市人民医院2015年1月-2017年12月收治的48例NEC患儿的临床资料,进行回顾性分析,根据修正Bell分期标准,了解患儿的一般信息、临床表现及治疗效果。 结果 38例患儿有喂养糌粑史;早产儿20例,足月儿28例;男21例,女27例;平均出生体质量(2 105.53±713.42)g;平均发病日龄(7.53±9.26)d。临床表现以腹胀(45例)、肠鸣音减弱(46例)、血便(16例)为主。实验室检查:白细胞异常10例,血小板减少6例,CRP增高15例。腹部X线检查:肠管扩张40例,肠壁增厚或积气32例,门静脉积气1例,气腹2例,腹腔积液3例。按照Bell分期标准:Ⅰ期10例,Ⅱ期32例,Ⅲ期6例。内科保守治疗44例,手术治疗4例;好转或治愈38例(79.2%),放弃治疗后死亡和死亡共10例(20.8%)。 结论 早期喂养糌粑是西藏高原地区NEC重要的致病因素,NEC临床治疗效果欠佳,应加强对NEC腹部X线表现的认识和判断水平,加强对NEC抗生素的合理应用,加强预防与早期诊断。 

Clinical analysis of 48 cases of neonatal necrotizing enterocolitis on the Tibetan Plateau,China

Objective To study the clinical features, ways of treatment and prognosis of neonatal necrotizing enterocolitis (NEC) on the Tibetan Plateau, improve awareness and prevention of the disease. Methods Forty-eight newborns suffering from NEC who were medically treated in our hospital from January, 2015 to December, 2017 were analyzed in this test.All cases were categorized by modified Bell's classification standard. We compared and analyzed clinical data of these NEC patients including general information, clinical manifestation, treatment, etc. Results Newborns receiving Zanba feeding were 38 cases, there were 20 preterm newborns and 21 male cases in this group. The average birth weight and day of onset were (2 105.53±713.42) g and (7.53±9.26)d. The main clinical features were abdominal distention, abdominal rumbling sound weakening or disappearance and bloody stools. There were 10 newborns with abnormality of leukocyte count, 15 infants with increased CRP, and 6 infants with diminished of blood platelets count. The most common of erect abdominal plain radiograph was bowel dilatation. There were 4 newborns received surgical intervention beside conventional medical treatment. Finally, 38 newborns (79.2%) were cured and 10 newborns (20.8%) were died (including parents giving up). Conclusion Early feeding of Zanba is an important disease factor in NEC on the Tibetan Plateau. The disease is more difficult to treat. We should enhance the understanding and judgment of radiographic features, establish guidelines of anti-infection, strengthen the prevention and early diagnosis.