Cikrit D, Mastandrea J, Grosfeld J L, West K W, Schreiner R L
J Pediatr Surg. 1985 Aug;20(4):425-30. doi: 10.1016/s0022-3468(85)80234-7.
Fifty-three of 177 infants with necrotizing enterocolitis (NEC) developed portal vein air (PVA). These infants were evaluated for prenatal, perinatal, therapeutic, clinical, laboratory, radiographic, and operative factors as they related to infants with and without PVA. A significantly higher incidence of PVA was seen in infants with NEC who weighed less than 2400 g (P less than 0.025). The use of Vitamin E (P less than 0.01), aminophylline, and high-density premature formula (P less than 0.001) was associated with an increased incidence of PVA. NEC totalis was seen in 55% of the infants with NEC and PVA (P less than 0.001). The presence of PVA was associated with a 58% mortality rate (P less than 0.05). Infants with NEC and PVA operated on prior to 1983 had a 71% mortality. Since 1983, seven of nine infants with NEC and PVA survived early operation using PVA as an indication for surgical intervention. In infants at risk for this highly lethal form of NEC, the avoidance of enteral feedings or altered dietary intake, cautious placement of arterial catheters and the judicious application of pharmacologic agents (eg, Vitamin E, aminophylline) is of importance in regard to prevention. These observations suggest that PVA is a sign of advanced disease and that these high-risk patients should be considered candidates for early surgical intervention.
177例坏死性小肠结肠炎（NEC）婴儿中有53例出现门静脉积气（PVA）。对这些婴儿的产前、围产期、治疗、临床、实验室、影像学和手术因素进行了评估，以了解它们与有、无PVA婴儿的关系。体重小于2400g的NEC婴儿中PVA发生率显著更高（P<0.025）。维生素E的使用（P<0.01）、氨茶碱和高浓度早产儿配方奶（P<0.001）与PVA发生率增加有关。55%的NEC合并PVA婴儿出现全坏死性小肠结肠炎（P<0.001）。PVA的出现与58%的死亡率相关（P<0.05）。1983年前接受手术的NEC合并PVA婴儿死亡率为71%。自1983年以来，9例NEC合并PVA婴儿中有7例在以PVA作为手术干预指征的早期手术中存活。对于有这种高致死性NEC风险的婴儿，避免肠内喂养或改变饮食摄入、谨慎放置动脉导管以及合理应用药物（如维生素E、氨茶碱）对于预防至关重要。这些观察结果表明，PVA是疾病进展的标志，这些高危患者应被视为早期手术干预的候选者。
