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目的分析早产极低出生体重儿并发坏死性小肠结肠炎(NEC)的危险因素,为临床制定早产极低出生体重儿预防NEC措施提供参考。方法分析2013-2015年东莞市妇幼保健院收治的早产极低出生体重儿437例临床资料,按照是否并发NEC将患儿分为两组,未并发NEC患儿376例设为对照组,并发NEC患儿61例设为观察组。比较两组患儿的临床诊治资料,采用卡方分析影响早产极低出生体重儿并发NEC的相关因素,将差异有统计学意义的指标纳入多因素Logistic回归方程中,分析早产极低出生体重儿并发NEC的危险因素。随访并比较两组患儿1年内的预后情况。结果两组患儿性别比较差异无统计学意义(P>0.05);观察组患儿抗菌药物应用率、败血症休克率、易感NEC相关药物应用率、围生期窒息率均明显高于对照组患儿,差异有统计学意义(P<0.05);出生时胎龄、体重及母乳喂养率明显低于对照组,出生后肠内喂养开始时间迟于对照组,差异均有统计学意义(P<0.05)。Logistic分析结果显示,有抗菌药物应用史、发生败血症休克、有NEC易感药物应用史、围生期窒息是早产极低出生体重儿并发NEC的危险因素,而母乳喂养是NEC的保护因素。两组患儿随访1年内观察组患儿死亡率、小头畸形率、严重神经发育问题率均远高于对照组患儿。结论早产极低出生体重儿并发NEC因素众多,临床诊治中易叠加,应尽可能采取综合预防措施,提高早产极低出生体重儿的预后质量。
Objective To analyze the risk factors of preterm very low birth weight infants with necrotizing enterocolitis (NEC) and provide a reference for the development of preterm very low birth weight infants to prevent NEC. Methods 437 cases of preterm low birth weight children admitted to Dongguan MCH hospital from 2013 to 2015 were divided into two groups according to whether they were complicated with NEC or not. 376 children without NEC were enrolled as the control group, with NEC 61 cases of children as the observation group. The clinical data of two groups of children were compared. The chi-square analysis was used to analyze the related factors of NEC in preterm very low birth weight infants. The statistically significant indexes were included in the multivariate Logistic regression equation. The prevalence of preterm low birth weight Concurrent NEC risk factors. Follow-up and comparison of two groups of children within 1 year prognosis. Results There was no significant difference in sex between the two groups (P> 0.05). The application rate of antibacterials, the rate of septic shock, the rate of susceptible NEC-related drugs and perinatal asphyxia in observation group were significantly higher than those in control group (P <0.05). The gestational age, body weight and breastfeeding rate at birth were significantly lower than those in control group. The time after enteral feeding started after birth was later than that in control group (P <0.05), and the difference was statistically significant (P <0.05). Logistic analysis showed that there were antimicrobial drug application history, septic shock and history of NEC susceptibility. Perinatal asphyxia was a risk factor for preterm very low birth weight infants with NEC. Breastfeeding was a protective factor for NEC. Children in the two groups were followed up for 1 year mortality rate in the observation group, microcephaly, the rate of serious neurological problems were much higher than the control group of children. Conclusions There are many NEC factors in preterm low birth weight infants, which are easily overlapped in clinical diagnosis and treatment. Comprehensive preventive measures should be taken to improve the prognosis quality of preterm low birth weight infants.