新生儿坏死性小肠结肠炎。基于临床分期的治疗决策。
Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging.
作者信息
Bell M J, Ternberg J L, Feigin R D, Keating J P, Marshall R, Barton L, Brotherton T
出版信息
Ann Surg. 1978 Jan;187(1):1-7. doi: 10.1097/00000658-197801000-00001.
A method of clinical staging for infants with necrotizing enterocolitis (NEC) is proposed. On the basis of assigned stage at the time of diagnosis, 48 infants were treated with graded intervention. For Stage I infants, vigorous diagnostic and supportive measures are appropriate. Stage II infants are treated medically, including parenteral and gavage aminoglycoside antibiotic, and Stage III patients require operation. All Stage I patients survived, and 32 of 38 Stage II and III patients (85%) survived the acute episode of NEC. Bacteriologic evaluation of the gastrointestinal microflora in these neonates has revealed a wide range of enteric organisms including anaerobes. Enteric organisms were cultured from the blood of four infants dying of NEC. Sequential cultures of enteric organisms reveal an alteration of flora during gavage antibiotic therapy. These studies support the use of combination antimicrobial therapy in the treatment of infants with NEC.
本文提出了一种针对坏死性小肠结肠炎（NEC）婴儿的临床分期方法。根据诊断时所确定的分期，对48例婴儿进行了分级干预治疗。对于I期婴儿，采取积极的诊断和支持措施是合适的。II期婴儿采用药物治疗，包括胃肠外和管饲氨基糖苷类抗生素，而III期患者则需要手术治疗。所有I期患者均存活，38例II期和III期患者中有32例（85%）在NEC急性发作期存活下来。对这些新生儿胃肠道微生物群的细菌学评估显示存在多种肠道微生物，包括厌氧菌。从4例死于NEC的婴儿血液中培养出了肠道微生物。肠道微生物的连续培养显示在管饲抗生素治疗期间菌群发生了变化。这些研究支持在NEC婴儿治疗中使用联合抗菌治疗。
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