Cikrit D, Mastandrea J, West K W, Schreiner R L, Grosfeld J L
Surgery. 1984 Oct;96(4):648-55.
One hundred one infants requiring operative treatment for necrotizing enterocolitis were evaluated for prenatal, perinatal, therapeutic, clinical, laboratory, radiographic, and operative factors as they relate to mortality. Infants less than 28 weeks gestation and those with birth weight less than 1500 gm had an increased mortality rate. The use of umbilical arterial catheters, high-density premature formulas, and aminophylline (for apnea) had an adverse effect on survival. Persistent acidosis, oliguria, and abdominal wall erythema resulted in a significantly worse outcome. The presence of portal vein air on abdominal radiograph was associated with a 71% mortality rate. The survival rate in infants with localized involvement was 70%. Thirty-eight percent of patients had extensive bowel involvement and a greater than 95% mortality rate. Avoidance of enteral feedings, cautious use of umbilical artery catheters, and judicious application of pharmacologic agents in infants at risk for necrotizing enterocolitis is of importance with regard to prevention. While medical management is feasible in some cases, persistent acidosis, oliguria, abdominal wall erythema, and portal vein air are associated with advanced disease. Infants with these risk factors should be candidates for prompt operative intervention.
对101例因坏死性小肠结肠炎需要手术治疗的婴儿，评估了与死亡率相关的产前、围产期、治疗、临床、实验室、影像学及手术因素。孕周小于28周及出生体重小于1500克的婴儿死亡率增加。使用脐动脉导管、高浓度早产配方奶及氨茶碱（用于治疗呼吸暂停）对生存率有不良影响。持续性酸中毒、少尿及腹壁红斑导致预后明显更差。腹部X线片显示门静脉积气的婴儿死亡率为71%。局限性病变婴儿的生存率为70%。38%的患者有广泛肠受累，死亡率超过95%。对于坏死性小肠结肠炎高危婴儿，避免肠内喂养、谨慎使用脐动脉导管及合理应用药物对预防很重要。虽然在某些情况下内科治疗可行，但持续性酸中毒、少尿、腹壁红斑及门静脉积气与疾病进展相关。有这些危险因素的婴儿应考虑尽早进行手术干预。
