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Clinical Analysis of Necrotizing Enterocolitis with Intestinal Perforation in Premature Infants

早産兒壞死性腸炎合併腸穿孔的預後因子

摘要


回顧分析20位早産兒壞死性腸炎合併腸穿孔的案例來尋找影響早産兒壞死性腸炎合併腸穿孔之預後因子。其中長期存活組有8位,死亡組有12位。在存活組有較低比例的腸穿孔前腸胃道餵奶、開放性動脈導管、indomethacin使用、酸血症以及休克,而且敗血症只在死亡組中出現。在存活組出現壞死性腸炎以及腸穿孔的時間都較早,而在死亡組從壞死性腸炎的診斷到合併腸穿孔的時間差距較短。另外剖腹手術發現在存活組的腸道壞列均侷限在迴盲腸區域而且在存活組有較多的單一腸穿孔,以上均具統計意義。另外根據不同的外科治療他們也被分爲三組:第一組6位只接受過腹腔引流,第二組3位先接受過腹腔引流之後接受剖腹探查手術,第三組11位直接接受衝腹探查手術。其中第一組與第二組的早産兒在懷孕週數與出生體重明顯第三組低,然而在死亡率三組並沒有統計上差異。我們的結論是以下因子:腸穿孔前腸胃道餵奶、開放性動脈導管、indomethacine使用、酸血症、休克、較晚發作的壞死性腸炎和腸穿孔、多發性腸穿孔和廣泛性的壞死病變均爲具有統計的造成預後不良的影響因子。腹腔引流是在危急情況的緊急復甦處置,而且通常最後大多數病人仍然需攷慮接受剖腹探查手術。

並列摘要


To identify the prognostic factors correlating with the outcome of the perforated necrotizing enterocolitis (NEC), the charts of 20 premature infants with perforated NEC were reviewed. Eight patients had long-term survival and 12 died. Infants in the survival group had significantly lower incidence of starting to feed before perforation, patent ductus arteriosus, indomethacin use, acidosis, and shock. Sepsis was only found in the group of infants that died. The survival group were diagnosed with NEC and intestinal perforation at an earlier age than the infants that died. The time from diagnosis of NEC to intestinal perforation was longer in the infants that died. The localization of necrosis from operative findings were all confined to the ileum-cecum area in survival group. The infants in the survival group were likely to have a single perforation. In addition, according to the operative management, they were divided into three groups: GroupⅠconsisted of six patients who received peritoneal drainage only, group Ⅱ consisted of three patients who received peritoneal drainage followed by laparotomy, and group Ⅲ consisted of 11patients who received primary laparotomy. Infants in groups Ⅰ and Ⅱ had significantly lower gestational ages and birth weights than group Ⅲ. There were no significant differences in mortality rates among infants in groups Ⅰ, Ⅱ and Ⅲ. We concluded that the factors including prior enteral feeding, patent ductus arteriosus, indomethacin use, acidosis, sepsis, shock, delayed onset of NEC and perforation, multiple perforation, and diffuse necrotic changes were significant prognostic factors of poor outcome. Peritoneal drainage was a resuscitative procedure in critical condition and laparotomy should mostly be considered as the final treatment in the infants with perforated NEC.

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