Clinical Observation of 43 Cases of Neonatal Necrotizing Enterocolitis

馬偕醫院自民國66年10月至民國72年12月，共經歷了43個新生兒壞死性腸炎的病例。其中早産兒有22個病例，另外21個病例是足月兒。男嬰有29例，女嬰有14例。診斷的依據乃依照病理檢查（包括屍體解剖和開刀所見）或臨床症狀加上典型的腹部X光特徵。我們發現，早産兒的病例有逐年增加的趨勢，而且常伴有週産期的合併症，如新生兒窒息、呼吸窘迫症、臍動脈或臍靜脈的插管、呼吸暫停、和早期破水。足月兒病例則與下痢有極大的關係。43例中無1例是以母奶哺育，而其中有2例早産兒在發生壤死性腸炎時，尚未開始哺育。臨床症狀常見的依次爲嗜睡或倦怠、腹脹、胃內容物滯留、呼吸暫停、血便和體溫不穩定。典型的腹部X光所見有腸壁積氣、肝門靜脈積氣、或腹膜內出現氧體。血液和腹水的細菌培養，以革蘭氏陰性菌爲主，其中以大腸桿菌最常見。以內科治療或外科治療的病例，其存活率都大約是三分之一。由於近2年來，我們對新生兒壞死性腸炎的早期診斷和早期治療，其存活率已提昇至二分之一。對於本症，除了有賴我們小兒科醫師對高危險性嬰兒隨時保持警覺，以期早期診斷和早期治療外，採取適當的預防措施，無疑的將是減少這踵新生兒悲劇的更理想方法。

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並列摘要

Forty three cases of necrotizing enterocolitis were reviewed. The affected infants were all artificially fed. There was a history of perinatal stress in the majority of premature babies and of protracted diarrhea in most of the term infants. The onset was most frequently observed to be in the first week of life. Common signs were lethargy, poor activity, abdominal distension, gastric retension and hematochezia. The diagnostic radiographic signs were pneumatosis intestinalis, portal vein gas and pneumoperitoneum. Gram negative bacilli were the predominent organism isolated from the blood and ascites. The overall svrvival rate in our series was 33%. In the last two years, the survival rate has improved to 50% because of early diagnosis and treatment.

並列關鍵字

necrotizing enterocolitis

國際替代計量

Clinical Observation of 43 Cases of Neonatal Necrotizing Enterocolitis

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