坏死性小肠结肠炎早产儿术后宫外发育迟缓的单中心研究

doi:10.12372/jcp.2025.25e0152

摘要/Abstract

摘要：

目的本研究旨在分析坏死性小肠结肠炎（NEC）早产儿术后发生宫外发育迟缓（EUGR）的危险因素，并探讨预防措施。方法研究选取2018至2024年新生儿科住院的72例行手术治疗的NEC早产儿，根据出院时体重与校正胎龄平均生长指标的关系分为EUGR组和非EUGR组。结果 NEC早产儿术后EUGR的发生率为65.28%，其中重度EUGR发生率为33.33%。单因素分析发现，出生胎龄、出生体重、1分钟Apgar评分、NEC发病时体重、氧疗方式比例、术中切除肠道长度、术后静脉营养时间、术后1周静脉营养中氨基酸最大量等因素与EUGR的发生相关，且有统计学意义。多因素logistic回归分析显示，1分钟Apgar评分高和发病时体重大是EUGR的保护因素，而术中切除肠道长度长是EUGR的危险因素。结论临床医师应关注出生时Apgar评分低、NEC发病时体重低的早产儿，减少术中肠道切除长度，加强围手术期营养评估，并个体化调整营养支持方案，以降低EUGR的发生率。

关键词: 宫外生长发育迟缓, 坏死性小肠结肠炎, 危险因素, 早产儿

Abstract:

Objective This study aimed to analyze the risk factors for extrauterine growth restriction (EUGR) in premature infants with necrotizing enterocolitis (NEC) after surgery and to explore preventive measures. Methods A total of 72 premature infants with NEC who underwent surgical treatment and were hospitalized in the neonatal department from 2018 to 2024 were selected. They were divided into EUGR and non-EUGR groups based on the relationship between their weight at discharge and the average growth indicators for corrected gestational age. Results The incidence of EUGR in NEC premature infants after surgery was 65.28%, with a severe EUGR incidence of 33.33%. Univariate analysis found that birth gestational age, birth weight, 1-minute Apgar score, weight at the onset of NEC, proportion of oxygen therapy methods, length of intestine resected during surgery, duration of postoperative intravenous nutrition, and the maximum amount of amino acids in intravenous nutrition within one week after surgery were statistically significant factors associated with the occurrence of EUGR. Multivariate logistic regression analysis showed that a high 1-minute Apgar score and a larger weight at the onset of NEC were protective factors for EUGR, while a longer length of intestine resected during surgery was a risk factor for EUGR. Conclusion Clinical physicians should pay attention to premature infants with low Apgar scores at birth and low weight at the onset of NEC, reduce the length of intestine resected during surgery, strengthen perioperative nutritional assessment, and adjust nutritional support plans individually to reduce the incidence of EUGR.

Key words: extrauterine growth retardation, necrotizing enterocolitis, risk factors, preterm infants

中图分类号:

杨梦园, 陈彦杉, 裴婉君, 李静, 董慧芳. 坏死性小肠结肠炎早产儿术后宫外发育迟缓的单中心研究[J]. 临床儿科杂志, 2025, 43(11): 823-829.

YANG Mengyuan, CHEN Yanshan, PEI Wanjun, LI Jing, DONG Huifang. A single - center study on extrauterine growth retardation in preterm infants after surgery for necrotizing enterocolitis[J]. Journal of Clinical Pediatrics, 2025, 43(11): 823-829.

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因素	非EUGR组（n=25）	EUGR组（n=47）	统计量	P
母亲年龄（$ \bar{x} \pm s$）/岁	32.88±4.78	31.00±5.50	t=1.44	0.154
母亲妊娠期高血压[n(%)]	5（20.00）	3（6.40）	χ²=1.84	0.175
母亲重度子痫前期[n(%)]	3（12.00）	1（2.10）	χ²=1.44	0.230
母亲妊娠期糖尿病[n(%)]	7（28.00）	9（19.10）	χ²=0.74	0.390
母亲妊娠期甲状腺功能减低[n(%)]	3（12.00）	4（8.50）	χ²=0.00	0.954
产前使用激素[n(%)]	20（80.00）	39（83.00）	χ²=0.00	1.000
剖宫产娩出[n(%)]	19（76.00）	30（63.80）	χ²=1.11	0.292
单胎[n(%)]	17（68.00）	28（59.60）	χ²=0.49	0.482
男婴[n(%)]	17(68.00)	35(74.50)	χ²=0.34	0.560
胎龄[M(P₂₅~P₇₅)]/周	31.00（28.29~34.00）	29.00（27.43~31.14）	Z=2.18	0.029
出生体重[M(P₂₅~P₇₅)]/g	1 680（1 420~2 300）	1 220（1 040~1 500）	Z=3.61	<0.001
出生时小于胎龄儿[n(%)]	0（0.00）	1（2.10）	-	1.000¹⁾
1min Apgar评分[M(P₂₅~P₇₅)]	9（8，10）	8（6，9）	Z=3.04	0.002
体重恢复至出生体重时间($\bar{x}±s$)/d	11.52±4.72	10.64±4.85	t=0.74	0.461

因素	非EUGR组（n=25）	EUGR组（n=47）	统计量	P
发病时日龄[M(P₂₅~P₇₅)]/d	14.00（9.50~19.50）	17.00（8.00~24.00）	Z=1.12	0.263
发病时体重[M(P₂₅~P₇₅)]/g	1 950（1 630~2 440）	1 450（1 200~1 750）	Z=3.33	0.001
发病时HFNC及以上氧疗[n(%)]	13（52.00）	39（83.00）	χ²=7.81	0.005
是否母乳喂养[n(%)]	10（40.00）	22（46.80）	χ²=0.31	0.580
术前是否达全肠内喂养[n(%)]	5（20.00）	3（6.40）	χ²=1.84	0.175
术前24~72 h血红蛋白[M(P₂₅~P₇₅)]/g·L^-1	118.00(100.50~138.00）	109.50（97.50~141.50）	Z=0.59	0.555
术前24~72 h白蛋白[M(P₂₅~P₇₅)]/g·L^-1	30.80(29.30~32.90)	29.75（28.03~31.88）	Z=1.19	0.235
术前1周内抗生素应用[n(%)]	13（52.00）	29（61.70）	χ²=0.63	0.427

因素	非EUGR组（n=25）	EUGR组（n=47）	统计量	P
肠穿孔[n(%)]	7（28.00）	11（23.40）	χ²=0.18	0.668
切除长度[M(P₂₅~P₇₅)]/cm	12.0（3.5~17.0）	21（18~31）	Z=3.94	<0.001
术后禁食时间[M(P₂₅~P₇₅)]/d	10（9~12）	10（8~12）	Z=0.48	0.630
术后静脉营养时间[M(P₂₅~P₇₅)]/d	18（12~27）	25（16~42）	Z=2.40	0.017
术后1周平均热卡（$\bar{x}±s$）/kcal·kg^-1·d^-1	73.52±13.89	75.57±11.90	t=0.66	0.512
术后1周平均非蛋白热能与氮的比值（$\bar{x}±s$）	159.90±19.65	154.46±20.22	t=1.10	0.277
术后1周PN氨基酸最大量[M(P₂₅~P₇₅)]/g·kg^-1·d^-1	3.1（3.0~3.5）	3.5（3.0~4.0）	Z=2.29	0.022
术后1周PN脂肪乳最大量[M(P₂₅~P₇₅)]/g·kg^-1·d^-1	3.0（3.0~3.6）	3.0（3.0~3.5）	Z=0.10	0.921
术后抗生素应用时间[M(P₂₅~P₇₅)]/d	12.0（9.0~16.5）	15（11,18）	Z=1.25	0.213
术后停止氧疗时间（$\bar{x}±s$）/d	25.33±14.73	29.03±17.42	t=0.08	0.941
术后应用白蛋白[n(%)]	23（92.00）	46（97.90）	χ²=0.32	0.570
术后输注悬浮红细胞[n(%)]	22（88.00）	46（97.90）	χ²=1.44	0.230
术后肝酶异常[n(%)]	13（52.00）	24（51.10）	χ²=0.01	0.940
术后合并胆汁淤积[n(%)]	11（44.00）	21（44.70）	χ²=0.00	0.956

因素	非EUGR组（n=25）	EUGR组（n=47）	χ²值	P
NRDS	24（96.00）	42（89.40）	0.27	0.601
败血症	2（8.00）	9（19.10）	0.82	0.364
BPD	7（28.00）	18（38.30）	0.76	0.382
ROP	4（16.00）	7（14.90）	0.00	1.000
颅内出血	3（12.00）	7（14.90）	0.00	1.000
重度脑室内出血	2（8.00）	1（2.10）	0.32	0.570
中度及以上贫血	16（64.00）	33（70.20）	0.29	0.590
低血糖	0（0.00）	2（4.30）	-	0.540¹⁾
代谢性骨病	4（16.00）	10（21.30）	0.05	0.821
布洛芬治疗的PDA	0（0.00）	4（8.50）	0.92	0.337

因素	β	S.E.	χ²值	P值	OR值	95%CI
发病时体重（每100克）	-0.223	0.106	4.423	0.035	0.800	0.650~0.985
1min Apgar评分	-0.515	0.261	3.895	0.048	0.597	0.358~0.996
术中切除肠道长度（每5厘米）	0.309	0.140	4.849	0.028	1.362	1.035~1.792