Tsai M C, Chen S N
Department of Pediatrics, Christian Hospital, Chianghua, Taiwan, R.O.C.
Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1995 Sep-Oct;36(5):328-30.
From 1984 to 1993, 25 neonates with gastroschisis were treated at Chianghua Christian Hospital (CCH). Twenty-one patients were outborn, and only four were inborn babies. Eighteen patients were treated by primary fascial closure of the abdominal wall defect and seven, by the silastic sac technique. One patient required creation of intestinal stomas for ileal atresia; Two patients received further operation because of pus formation and intestinal obstruction. Four patients (16%) had associated anomalies, including one ileal atresia, two malrotations and one deformity of the hand. Seven (28%) patients were small for their gestational age. Eight patients died (32%); 17 survived (68%). Nine patients (36%) were hypothermic upon arrival at the hospital, with body temperatures of 32.5 degrees C to 35.8 degrees C. Among those, three died of intractable metabolic disorders related to hypothermia and two who were hypothermal and acidotic, developed sepsis and expired. Six patients (24%) developed sepsis and only one survived. Metabolic acidosis related to hypothermia and sepsis were the major causes of death in this study (P values of 0.024 and 0.01 respectively). It is no doubt that an experienced pediatrician is essential for immediate neonatal care to prevent unnecessary insults.
1984年至1993年期间，彰化基督教医院（CCH）共收治了25例腹裂新生儿。其中21例为外院出生，仅4例为本院出生。18例患者采用腹壁缺损一期筋膜缝合术治疗，7例采用硅橡胶囊技术治疗。1例患者因回肠闭锁需行肠造口术；2例患者因脓肿形成和肠梗阻接受了进一步手术。4例患者（16%）合并其他畸形，包括1例回肠闭锁、2例肠旋转不良和1例手部畸形。7例（28%）患者出生时体重低于孕周。8例患者死亡（32%）；17例存活（68%）。9例患者（36%）入院时体温过低，体温在32.5摄氏度至35.8摄氏度之间。其中，3例死于与体温过低相关的顽固性代谢紊乱，2例体温过低且酸中毒的患者发生败血症后死亡。6例患者（24%）发生败血症，仅1例存活。体温过低和败血症相关的代谢性酸中毒是本研究中的主要死亡原因（P值分别为0.024和0.01）。毫无疑问，经验丰富的儿科医生对于新生儿的即时护理以防止不必要的损伤至关重要。
