[新生儿坏死性小肠结肠炎危险因素分析]新生儿小肠结肠炎手术
时间：2019-01-14 04:45:56 来源：达达文档网 本文已影响 人 
【摘要】 目的 探讨新生儿坏死性小肠结肠炎(NEC)的危险因素及其在NEC发病中起到的作用。方法 2003年1月至2007年12月在广州医学院第三附属医院新生儿科住院确诊为NEC的32例患儿为病例组,同期在本院产科出生的32例健康新生儿为对照组。归纳出可能引起NEC的早产、窒息、孕高征等19个疑似危险因素,用SPSS 13.0软件进行Logistic回归分析。通过Logistic分析,筛选出有统计学意义的危险因素。结果 最终筛选出NEC的危险因素有3个,分别为早产、窒息、非母乳喂养因素,其他因素被回归方程排除。OR值分别为:19.474、12.966和16.245。结论 本次回归分析显示,早产因素在三者中的OR值最高达19.474,引起NEC的风险最大。但母亲的孕期健康状况作为一个间接诱因也不能忽视。因此做好围产期保健,减少早产儿及低体重儿的出生,防止窒息的发生,提倡母乳喂养是预防NEC的关键。
【关键词】 新生儿;坏死性小肠结肠炎;危险因素
Analysis on the risk factors which cause neonatal necrotizing enterocolitis
LI Jun, LI Song,CUI Qi-liang.
Department of Pediatrics,the Third Affiliated Hospital of Guangzhou Medical College,Guangzhou 510150,China
【Abstract】 Objective To explore the risk factors of NEC and the function of these factors in the NEC. Methods 32 hospital neonatalwho were diagnosed as NEC during January 2003 to December 2007 were selected as the case group,while 32 healthy babies who were born in the same duration were selected as the control group.Conclude the 19 uncertain risk factors for the NEC about premature labor,asphyxia andPregnancy-induced Hypertension et al, use Logistic regression to analyze the data above by the software of SPSS 13.0,screen out the risk factors which have statistical signification. Results There are threerisk factors of statistical significant which were selected. They are premature labor,asphyxia andnon-breast feeding respectively.The other factors were excluded by the Logistic regression equation. The result of OR is respectively 19.474,12.96 and 16.245. Conclusion The data shows theOR valueof premature labor is the highest in the three risk factors,but we cann’t neglect the Pregnant disease and the other factors.Pregnant disease is maybe a indirect factor for the NEC.Thereby, the keys of prevention NEC are reducing the incidence rate of the premature delivery and asphyxia,controing infection and feed baby in correct way.
【Key words】 Neonates; Necrotizing enterocolitis; Risk factors
�
新生儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)是一种很常见的后天获得性的新生儿急腹症。国外研究认为它是各种原因引起的肠局部缺血、肠黏膜受到致病菌产生的毒素损害而导致坏死性的肠道病变,在活产婴儿中发生率�1/1000～3/1000�,发病的新生儿当中肠穿孔发生率占1/3。NEC相关的危险因素包括早产和低出生体重,尤其是极低体重儿(VLBW),胎龄20×109/L 4例;血培养阳性4例,其中大肠埃希菌2例及金黄色葡萄球菌1例,真菌1例。
1.2.8 X线检查 肠间隙增厚7例,胃肠动力性肠梗阻4例,气腹3例。
1.2.9 治疗及愈后 ①保守治疗:禁食、胃肠减压、静脉输液(保证液体入量及基础代谢热卡)、抗生素及输血、血浆、血小板、复方氨基酸等支持疗法。并根据病情复查腹片及大便潜血;②手术治疗:3例肠穿孔并发腹膜炎的患儿行开腹手术腹腔引流;③转归:治愈20例、好转3 例、死亡9例。
本文为全文原貌 未安装PDF浏览器用户请先下载安装 原版全文 1.3 统计学方法
1.3.1 各危险因素赋值说明 针对NEC的危险因素将上述资料归纳为二大类:一是母亲患病情况,二是婴儿出生及患病情况,共19个危险因素。设NEC为应变量(Y),取值0或1,0表示出现阴性结果,1表示出现阳性结果。各危险因素为自变量(X1～X19),取值0,1,2,…K。0表示非暴露,1,2,…K表示暴露,数值越大暴露水平越高。上述资料采用SPSS 13.0统计软件进行分析,统计学方法为Logistic回归法。
1.3.2 SPSS 13.0参数设定 由于自变量数目较大,为了使建立的Logistic回归模型比较稳定和便于解释,尽可能将回归效果显著的自变量选入模型中,作用不显著的自变量则排除在外。Logistic回归参数设置为后退法和Wald检验,设定最多进行20步筛选。取95% 可信区间,α入=0.1,α出=0.15。
表1
各危险因素的赋值
危险因素变量名赋值说明
母亲孕期患病情况妊娠高血压(X1)无=0有=1
妊娠糖尿病(X2)无=0有=1
脐带脱垂(X3)无=0有=1
前置胎盘(X4)无=0有=1
血小板减少(X5)无=0有=1
婴儿出生及患病情况性别(X6)男=0女=1
胎龄(X7)≥37周=0 29~34周=234-37周=18=0 4-8=1 本文为全文原貌 未安装PDF浏览器用户请先下载安装 原版全文
