周產期足月兒之上消化道出血

Perinatal Upper Gastrointestinal Bleeding in Full-term Neonates

陳銘華(Ming-Hua Chen)

《北市醫學雜誌》 4卷7_S期 (2007/07) Pp. 579-582

https://doi.org/10.6200/TCMJ.2007.4.7.09

摘要

早在15年前，筆者即已發表一篇「胎兒胃潰瘍」病例報告(Fetal Gastic ulcer Presenting with Bloody Amniotic Fluid)於「J of Pediatric Gastroenterology and Nutrition」雜誌上，兩年後，Bendu A et al發表另一篇報告「Prenatal Gastrointestinal Bleeding caused by Esophagitis」於「J of Pediatrics」此後，凡是有關於足月兒之上消化道出血之國際論文期刊，引用筆者該篇罕見報告之頻率極高。周產期上消化道出血與嬰幼兒或大小孩上消化道出血，其最主要的區別在於（一）大都在出生的3天內發生，如果是子宮內出血，則羊水呈現紅色，但是胎盤正常（二）咖啡狀嘔吐物，大都極輕微，這也是此症被嚴重低估的主因。（三）大都是胃潰瘍或下食道潰瘍，而無十二指腸潰瘍。而此症的最主要危險因子是①胎兒窘迫症②產程不順或太長③母體在懷孕末期曾服用制酸劑者④社經地位較差者⑤母體有身心障礙者⑥新生兒之血清pepsinogen較高者⑦因母乳中含有platelet activating factor acetyl-hydrolase，所以母乳哺育者較不會胃出血⑧缺氧。總之，新生兒胃內視鏡檢查，只要on EKG monitor，注意氧氣飽合度,不需要sedation，是一極安全的檢查。目前，台灣真正的盛行率仍不知，尚有待大規模的研究。筆者相信，應該會高於意大利1.23%的盛行率。只有積極的胃內視鏡檢查，才能發現，更多被誤診的病例，才能證實這是一個「常見」的疾病。

關鍵字

周產期 ； 足月兒 ； 上消化道出血

並列摘要

Upper gastrointestinal bleeding secondary to esophagitis, gastritis, or peptic ulcer is uncommon during the perinatal period, even in the sick premature baby. Clinically, it may vary from minimal hematemesis to massive tarry stool. Causes of the early onset acute esophagogastric lesions remain unknown. Various risk factors have been suggested, including maternal social stress, fetal distress, maternal antacid drug usage during the last month of pregnancy or traumatic upper digestive tract suction. Berhamou PH et al reported breast feeding during the first days of life had protective effect. In 1992, we reported a case of ”Fetal gastric ulcer presenting with bloody amniotic fluids”, to the best of our knowledge, this is the first reported case of gastric ulcer occurred in utero with unknown cause in the English literature. Two years later, Bendu A et al reported a case of premature baby with prenatal upper gastrointestinal bleeding. Since then, we had great interest in the field of upper gastrointestinal bleeding happened perinatally, and considered it is an and underestimated disease. Previous studies were all focused on upper digestive tract bleeding occurred during the neonatal period after one month of age, until Lazzaroni M et al reported up to 1.23% (64/5180) of healthy full-term neonates suffered from upper gastrointestinal bleeding with 26.5+20hrs. of life in Italy. We conclude that neonatal upper panendoscopy is a safe procedure, perinatal peptic ulcer disease may become a common disorder when aggressive panendoscopy is applied to those cases with minimal evidence of upper gastrointestinal bleeding.

並列關鍵字

perinatal ； upper gastrointestinal bleeding ； Full-term neonate