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发育医学电子杂志  2022, Vol. 10 Issue (5): 360-364    DOI: 10.3969/j.issn.2095-5340.2022.05.006
  围产医学   论著 |新生儿 |
新生儿坏死性小肠结肠炎造瘘术后肠衰竭相关性肝病的影响因素分析
李广 张艳平 张英娜 韩金宝 余梦楠 刘钢 黄柳明 张珊
解放军总医院儿科医学部 解放军总医院第七医学中心儿科研究所 出生缺陷防控关键技术国家工
程实验室 儿童器官功能衰竭北京市重点实验室,北京 100700
Analysis of influencing factors of intestinal failure associated liver disease after enterostomy in neonatal necrotizing enterocolitis
Li Guang, Zhang Yanping, Zhang Yingna, et al
Beijing Key Laboratory of Pediatric Organ Failure, National Engineering Laboratory for Birth defects
prevention and control of key technology, Institute of Pediatrics, the Seventh Medical Center of PLA General
Hospital, Faculty of Pediatrics, the Chinese PLA General Hospital, Beijing 100700, China
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摘要 【摘要】 目的  分析新生儿坏死性小肠结肠炎(neonatal necrotizing enterocolitis,NEC)造瘘术后肠衰竭
相关性肝病(intestinal failure associated liver disease,IFALD)的影响因素。 方法 采用回顾性研究方法,选取2018 年1 月1 日至2022 年1 月31 日在解放军总医院第七医学中心收治的初诊为NEC 并行肠造
瘘及还纳手术的78 例患儿为研究对象。根据患儿是否合并IFALD 分为未合并IFALD 组(n=51)与合
并IFALD 组(n=27)。分析两组患儿的临床资料,并对术后发生IFALD 的相关因素进行分析。统计学方
法采用χ2 检验、t 检验以及多因素Logistic 回归分析。 结果 合并IFALD 组与未合并IFALD 组的早
产儿比例分别为[92.6%(25/27)与72.5%(37/51),χ2=4.084,P=0.043];低出生体质量儿比例分别为[88.9%(24/27)与70.6% (36/51),χ2=4.722,P=0.030];造瘘术后剩余小肠长度<40 cm 的比例分别为[37.0%(10/27)与5.9%(3/51),χ2=12.764,P=0.001];并发脓毒血症发生率分别为[37.0%(10/27)与11.8%(6/51),χ2=7.456,P=0.039],合并IFALD 组均高于未合并IFALD 组,且差异均有统计学意义。合并IFALD 组与未合并IFALD 组患儿的术后开奶天数分别为[(10±5)与(9±4)d,t=-1.241,P=0.021];达到全肠道喂养所需平均天数分别为[(50±19)与(27±13)d,t
=3.341,P<0.001],合并IFALD 组均长于未合并IFALD组。多因素Logistic 分析显示,达到全肠道喂养所需天数与IFALD 发生呈正相关(OR=1.075,P=0.001),并发脓毒血症与IFALD 发生呈正相关(OR=5.427,P=0.027)。 结论 NEC 小肠造瘘术后患儿,待病情稳定后早日达到全肠道喂养,积极预防感染是改善IFALD 结局的重要因素。
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关键词:  坏死性小肠结肠炎  肠衰竭相关肝病  关瘘术  短肠综合征  肠内营养    
Abstract: 【Abstract】 Objective To analyze the influencing factors and interventions of intestinal failure associated liver disease (IFALD) fistula after enterostomy in neonatal necrotizing enterocolitis (NEC). Method FromJanuary 1, 2018 to January 31, 2022, 78 neonates with NEC who underwent enterostomy and repaymentsurgery in the Seventh Medical Center of PLA General Hospital were selected as the research objects by aretrospective study method. According to the presence or absence of IFALD, the children were divided intothe non-IFALD group (n=51) and the IFALD group (n=27). The clinical data of the two groups were analyzed,and the related factors of IFALD after operation were analyzed. Chi-square test, t-test and multivariateLogistic regression were used for statistical analysis. Result The proportion of preterm infants in theIFALD group and the non-IFALD group were [92.6% (25/27) vs 72.5% (37/51), χ2=4.084, P=0.043],respectively; the proportion of low birth weight infants were [88.9% (24/27) vs 70.6% (36/51), χ2=4.722,P=0.030], respectively; the proportion of residual small intestine length <40 cm after enterostomy were [37.0%(10/27) vs 11.8% (6/51), χ2=7.456, P=0.039], respectively; the incidence of sepsis was [37.0% (10/27) vs5.9% (3/51), χ2=12.764, P=0.001]; Which in the IFALD group were all higher than those in the non-IFALDgroup, and the difference were statistically significant. The days of postoperative lactation in IFALD groupand non-IFALD group were [(10±5) vs (9±4) d, t=-1.241, P=0.021], respectively. The number of daysneeded to reach whole intestinal feeding were [(50±19) vs (27±13) d, t=3.341, P<0.001], respectively; andthe IFALD group was all longer than the non-IFALD group, and the difference were statistically significant.Multivariate Logistic analysis showed that the number of days to complete enteral feeding was positivelycorrelated with the occurrence of IFALD (OR=1.075, P=0.001). Sepsis was positively correlated with IFALD(OR=5.427, P=0.027). Conclusion The children with NEC after enterostomy should be fed as soon aspossible when their condition is stable, and actively prevent infection are important factors to improvethe outcome of IFALD.
Key words:  Neonatal necrotizing enterocolitis    Intestinal failure associated liver disease    Enstomaclosure    Short-bowel syndrome    Enteral nutrition
收稿日期:  2022-05-16                     发布日期:  2022-09-30     
基金资助: 计生专项科研课题(21JSZ18)
通讯作者:  张珊    E-mail:  zhangs6349@163.com
引用本文:    
李广 张艳平 张英娜 韩金宝 余梦楠 刘钢 黄柳明 张珊. 新生儿坏死性小肠结肠炎造瘘术后肠衰竭相关性肝病的影响因素分析[J]. 发育医学电子杂志, 2022, 10(5): 360-364.
Li Guang, Zhang Yanping, Zhang Yingna, et al. Analysis of influencing factors of intestinal failure associated liver disease after enterostomy in neonatal necrotizing enterocolitis. Journal of Developmental Medicine(Electronic Version), 2022, 10(5): 360-364.
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