Necrotizing Enterocolitis Complicated with Perforation in Extremely Low Birth-Weight Premature Infants

超低出生體重早產兒的壞死性腸炎合併腸穿孔

吳家華(Chia-Hua Wu) ； 曹伯年(Po-Nien Tsao) ； 周弘傑(Hung-Chieh Chou) ； 唐禎瑞(Jen-Ruey Tang) ； 陳維江(Wai-Kong Chan) ； 鄒國英(Kuo-Inn Tsou)

《Acta Paediatrica Taiwanica》 43卷3期 (2002/06) Pp. 127-132

https://doi.org/10.7097/APT.200206.0127

摘要

通個研究主要是想瞭解，超低出生體重早產兒壞死性腸炎合併腸穿孔的發生率、臨床表現、治療及預後的情形。我們收集了從1993年1月至2000年12月篇止，共有八位在臺大醫院經診斷並接受治療的病患。超低出生體重早產兒壞死性腸炎合併腸穿孔的發生率是5.1%(8/158)。診斷出來的時間平均是出生後的第26天，最常見的監床表現是腹脹、腸蠕動減少和活動力變差。而診斷出來的主要徵兆是擴大且固定不動的腸氧、增厚的腸壁及從腹腔引流管中流出像糞便的物質。血小板減少、CRP上升和貧血則是最常見的實驗室檢查結果。所有的病患，都在疾病的急性期接受了腹腔引流術。全部的存活率是37.5%(3/8)。死亡的病患中，有三位是死於院內感染且併發敗血症；而有二位是死於壞死性腸炎合併腸穿孔。其餘存活的三位病患中，有二位分別於罹病後的第19天及第41天，開始接受腸道進食；另一位則於罹病後的第二年仍需要完全靜脈營養治療。對於超低出生體重早產兒，想藉由監床和影像學的檢查，以早期就確定診斷壞死性腸炎合併腸穿孔，到目前為止仍然有不少的困難存在。但是從我們的經驗中得知，即使在疾病的急性期，未能於腹腔中發現遊離的氧體，卻可由腹部超音波診斷出有腹水，進而從腹腔引流管中流出像糞便的物質，如此仍可視為是已發生腸穿孔的一項有意羲的徵兆。此外，監床上細心的觀察以求早期診斷，更積極的外科治療、同時預防並控制之後的院內感染，如此措施或許可以降低超低出生體重早產兒發生壞死性腸炎合併腸穿孔的死亡率。

關鍵字

壞死性腸炎 ； 超低出生體重 ； 早產兒

並列摘要

This study determined the incidence, clinical characteristics, treatment and outcome in extremely low birth-weight (ELBW) premature infants with perforated necrotizing enterocolitis (NEC). We retrospectively reviewed the medical records of ELBW (birth weight ＜1000 g) premature infants with perforated NEC diagnosed and managed at National Taiwan University Hospital (NTUH) from January 1993 through December 2000. A total of 8 ELBW premature infants with perforated NEC were collected. The incidence of perforated NEC in ELBW premature infants was 5.1% (8 out of 158). The average age at onset of perforated NEC was 26 days. The most common clinical features were abdominal distention, decreased bowel sound and poor activity level. Dilated and fixed bowel loops, bowel wall thickening and ascites with stool-like substance drainage out from penrose drain tube were the predominant signs at the time of diagnosis of perforated NEC. Thrombocytopenia, elevated C-reactive protein and anemia were the major laboratory findings. All infants received a primary penrose drain in the acute stage of disease. The overall survival rate was 37.5% (3 out of 8). Death occurred due to nosocomial infection with sepsis in 3 patients and due to perforated NEC in 2 patients. Two of the three surviving patients started enteral feeding 19 and 41 days after the diagnosis of perforated NEC and tolerated oral feedings well; the third patient still required total parenteral nutrition two years after diagnosis. Although the clinical characteristics and radiographic findings of perforated NEC in ELBW premature infants were variable, brown color ascites with stool-like substance may be considered a significant sign of perforated NEC despite the absence of free air on radiography at the early stage of disease. Close observation of clinical symptoms and signs, more aggressive surgical intervention and prevention of the following nosocomial infection may have the opportunity to reduce the mortality due to perforated NEC. (Acta Paediatr Tw 2002; 43:127-32)

並列關鍵字

necrotizing enterocolitis ； extremely low birth-weight ； prematurity