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目的:分析早产儿坏死性小肠结肠炎(NEC)发生的影响因素。方法:收集2008年1月~2011年12月在南方医科大学附属小榄医院、厦门大学附属第一医院和南京医科大学附属南京儿童医院等3家NICU住院的NEC及非NEC早产儿。NEC按修正Bell评分标准进行诊断和分度。采用调查表形式收集临床资料,包括母亲产科因素、产时情况、新生儿一般情况、疾病情况和有无应用益生菌等。采用SAS9.1统计软件包行单因素和多因素分析,分析早产儿NEC的保护因素或危险因素。结果:NEC组早产儿59例;对照组早产儿95例。早产儿NEC危险因素的单因素分析显示,胎龄、出生体重、窒息、肺炎、呼吸衰竭、用氧、发病前喂养、高胆红素血症、败血症、感染性休克、弥漫性血管内凝血、低钠血症、低钙血症和益生菌等14项具有统计学意义(P<0.05)。早产儿NEC的多因素分析Logistic回归分析显示,高胆红素血症(OR=0.059,95%CI:0.015~0.228,P<0.01)、益生菌(OR=0.017,95%CI:0.003~0.110,P<0.01)和出生体重(OR=0.999,95%CI:0.998~1,P<0.05)为早产儿NEC保护因素;肺炎(OR=5.343,95%CI:1.429~19.983,P<0.05)为危险因素;喂养(OR=0.010,95%CI:0.001~0.236,P<0.01)与基础疾病有关。结论:高胆红素血症、益生菌和出生体重是早产儿NEC保护因素,肺炎为危险因素。
Objective: To analyze the influencing factors of necrotizing enterocolitis (NEC) in preterm infants. Methods: From January 2008 to December 2011, NEC and non-NEC preterm infants were enrolled in three NICUs including Xiaolan Hospital affiliated to Southern Medical University, First Affiliated Hospital of Xiamen University and Nanjing Children’s Hospital Affiliated to Nanjing Medical University. NEC is calibrated and indexed according to the modified Bell score. Clinical data were collected using a questionnaire, including maternal obstetric factors, time of birth, general conditions of newborns, disease status and the presence or absence of probiotics. SAS9.1 statistical package using single factor and multivariate analysis, analysis of protective factors or risk factors for NEC in preterm children. Results: There were 59 preterm infants in NEC group and 95 premature infants in control group. Univariate analysis of risk factors for NEC in preterm infants showed that gestational age, birth weight, asphyxia, pneumonia, respiratory failure, prenatal feeding with oxygen, hyperbilirubinemia, septicemia, septic shock, disseminated intravascular coagulation, Hyponatremia, hypocalcemia and probiotics 14 were statistically significant (P <0.05). Logistic regression analysis showed that hyperbilirubinemia (OR = 0.059, 95% CI: 0.015-0.228, P <0.01), probiotics (OR = 0.017, 95% CI: 0.003-0.110 (OR = 5.343, 95% CI: 1.429-19.983, P <0.05), P <0.01) and birth weight (OR = 0.999,95% CI: 0.998-1, As risk factors; feeding (OR = 0.010, 95% CI: 0.001-0.236, P <0.01) was associated with underlying disease. Conclusions: Hyperbilirubinemia, probiotics and birth weight are the protective factors of NEC in neonates and pneumonia is a risk factor.