新生儿坏死性小肠结肠炎患儿术中补液量对术后转归的影响

Influence of intraoperative fluid replacement on postoperative outcomes in pediatric patients with neonatal necrotizing enterocolitis

摘要:

目的：评估新生儿坏死性小肠结肠炎（neonatal necrotizing enterocolitis，NEC）手术患者术中晶体输注量与术后转归的关系。方法：回顾性分析2012年1月至2018年9月在重庆医科大学附属儿童医院确诊NEC并接受手术的172 例患儿的临床资料，以校正术中输入晶体量后中位数为标准，将患儿分为低晶体组[<25.89 mL/（kg·h）]与高晶体组[>25.89 mL/（kg·h）]，监测术后开奶时间、首次排便时间、是否发生并发症、重症监护治疗时间及术后住院时间、死亡、术后90 d内不能完全肠内营养等术后指标，进行比较分析。结果：单因素分析结果显示，2组患儿术后并发症发生率差异有统计学意义（P<0.05）。将术后单因素分析P<0.05的变量纳入logistic向后逐步回归分析得到，输液量（OR=0.955，95%CI=0.914～0.997，P=0.036）是术后并发症发生的保护因素。结论：增加术中输液量可降低术后并发症发生率。

Abstract:

Objective：To evaluate the relationship between intraoperative crystalloid administration and postoperative outcomes in pe－diatric patients with neonatal necrotizing enterocolitis（NEC）. Methods：A total of 172 NEC patients undergoing surgery from January 2012 to September 2018 in our hospital were retrospectively analyzed and were divided into the low crystalloid group[<25.89 mL/（kg·h）] and the high crystalloid group[>25.89 mL/（kg·h）] by taking median after correcting input crystalloid amount as standard. First time to enteral feeds，first defecation，the incidence of complications，the postoperative length of NICU or ICU stay，postoperative death and incomplete enteral nutrition within 90 days after surgery were monitored and compared. Results：The univariate analysis showed that the incidence of postoperative complications was significantly different in two groups（P<0.05）. Variables with P<0.05 in univariate analysis were included in stepwise backward logistic regression analysis and it was identified that crystalloid administration was an independent protective factor of postoperative complications（OR=0.955，95%CI=0.914－0.997，P=0.036）. Conclusion：The intraopera－tive crystalloid administration can reduce the risk of postoperative complications.