新生儿便血临床特征分析(附292例病例报道)

doi:10.3969/j.issn.1671-7171.2018.08.009

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摘要【目的】探讨新生儿便血住院患儿的临床特征和转归,为临床早期诊断和治疗提供思路。【方法】选取2014年10月至2017年6月本院新生儿外科和新生儿内科收治的292例新生儿便血患儿,分析其临床资料,包括性别、年龄、体质量、症状、体征、辅助检查、治疗方法及预后等,比较早产儿与足月儿便血的特点。【结果】 292例新生儿便血患儿中,鲜红色血便46例、暗红色血便212例、柏油样便34例;贫血98例、失血性休克8例;呕吐105例(36.0%),腹胀77例(26.4%)。足月儿228例,主要病种为牛奶蛋白过敏(CMPA)、感染性肠炎和新生儿坏死性小肠结肠炎(NEC)。早产儿64例,主要病种为NEC、CMPA和应激性溃疡。足月儿平均发病年龄为(10.16±8.70)d,早产儿平均发病年龄为(8.93±8.18)d,两组比较差异无统计学意义(t=1.019, P=0.309)。保守治疗242例,手术治疗50例;治愈262例(89.7%),好转20例(6.8%),病死10例(3.4%)。足月儿和早产儿病死率比较差异无统计学意义(χ²=0.290,P=0.591)。病死原因主要为延迟手术和严重感染导致小肠大部分坏死,主要病种为肠旋转不良和NEC。【结论】新生儿便血以男性患儿多见,足月儿占大部分,病种以CMPA、NEC和感染性肠炎常见;对于合并腹胀和呕吐者,应警惕外科疾病,及时诊断和正确治疗可提高治愈率。

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关键词 ：便血, 胃肠出血, 婴儿, 新生

Abstract：【Objective】 To explore the clinical features and prognosis of hospitalized neonates with hematochezia, and to provide ideas for early diagnosis and treatment.【Methods】 From October 2014 to June 2017, 292 cases of neonatal hematochezia were selected and analyzed, including sex, age, body weight, symptoms, signs, auxiliary examinations, treatment methods and prognosis, etc. The characteristics of hematochezia between preterm infants and full-term infants were compared.【Results】 Among the 292 neonates with hematochezia, there were 46 cases of bright red blood stool, 212 cases of dark red blood stool, 34 cases of tar stool, 98 cases of anemia, 8 cases of hemorrhagic shock, 105 cases of vomiting (36.0%) and 77 cases of abdominal distension (26.4%). 228 cases of term infants, the main diseases are milk protein allergy (CMPA), infectious enteritis and neonatal necrotizing enterocolitis (NEC). There were 64 premature infants. The main diseases were NEC-CMPA and stress ulcer. The mean onset age of full-term infants was (10.16 ±8.70) days, and that of premature infants was (8.93 ±8.18) days. There was no significant difference between the two groups (t=1.019,P=0.309). 242 cases were treated conservatively, 50 cases were operated, 262 cases were cured (89.7%), 20 cases were improved (6.8%), 10 cases died (3.4%). There was no significant difference in mortality between full-term infants and premature infants (χ²=0.290). The main causes of death were delayed operation and severe infection leading to most necrosis of the small intestine. The main diseases were intestinal malrotation and NEC.【Conclusion】 Hematochezia is more common in male infants than in full-term infants, and CMPA, NEC and infectious enteritis are common diseases. For those complicated with abdominal distension and vomiting, surgical diseases should be observed, and timely diagnosis and correct treatment could improve the cure rate.

Key words： Hemafecia Gastrointestinal Hemorrhage Infant Newborn

收稿日期: 2018-05-11

PACS:

R722.152

引用本文:

许光, 周崇高, 王海阳, 邹婵娟, 李碧香. 新生儿便血临床特征分析(附292例病例报道)[J]. 医学临床研究, 2018, 35(8): 1483-1486.
XUGuang, ZHOUChong-gao, WANGHai-yang, et al. Analysis of Clinical Features of Hematochezia in Newborns (A Report of 292 Cases). JOURNAL OF CLINICAL RESEARCH, 2018, 35(8): 1483-1486.

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http://www.jcr.net.cn/CN/10.3969/j.issn.1671-7171.2018.08.009 或 http://www.jcr.net.cn/CN/Y2018/V35/I8/1483

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