【摘要】：目的分析總結(jié)新生兒胃腸道穿孔的臨床特征及病原學(xué),指導(dǎo)臨床診療。方法總結(jié)并分析95例患兒病例的一般資料、癥狀、體征、穿孔情況、病因、病原學(xué)檢查、治療及預(yù)后。結(jié)果(1)95例新生兒胃腸道穿孔主要臨床表現(xiàn)為腹脹(85例,89.47%)及嘔吐(55例,57.89%),體溫異常31例(32.63%),體征以腹部膨隆(85例,89.47%)、腹壁發(fā)紅(52例,54.74%)、腹壁靜脈怒張(44例,46.32%)為最常見;(2)術(shù)中穿孔部位得到了證實并明確,穿孔部位位于小腸(45例,47.37%)、結(jié)腸(40例,42.11%)、胃(10例,10.53%),小腸穿孔中最常見的部位為回腸(33例,73.33%),結(jié)腸穿孔中最常見的是橫結(jié)腸(11例,27.50%);(3)95例患兒中有61例在手術(shù)中取得腹腔滲液送細(xì)菌培養(yǎng),46例培養(yǎng)陽性,共培養(yǎng)出53株病原菌,G-性菌40株(75.47%),其中肺炎克雷伯菌肺炎亞種(15株,37.5%)檢測出最多,其次為大腸埃希氏菌(12株,30%);G+性菌13株,分別為屎腸球菌7株(53.85%)、表皮葡萄球菌3株(23.08%)、糞腸球菌2株(15.38%);(4)術(shù)中綜合分析患兒全身情況、穿孔部位,以挽救患兒生命為最終目的,采取簡單有效手術(shù)方式,最常見的術(shù)式為腸造瘺術(shù),臨床治愈率為82%,預(yù)后較好。(4)術(shù)中綜合分析患兒全身情況、穿孔部位,以挽救患兒生命為最終目的,采取簡單有效手術(shù)方式,最常見的術(shù)式為腸造瘺術(shù),臨床治愈率為82%,預(yù)后較好。結(jié)論新生兒胃腸道穿孔臨床表現(xiàn)不典型,不明原因的腹脹伴有嘔吐、發(fā)熱等表現(xiàn),結(jié)合腹部查體應(yīng)警惕消化道穿孔的可能,通過腹部攝片發(fā)現(xiàn)氣腹確診;術(shù)中取腹腔滲液做檢測,檢測出最多的病原菌為革蘭陰性菌,其中肺炎克雷伯菌肺炎亞種、大腸埃希氏菌菌最為常見,可選用半合成青霉素+第三代頭孢類+硝基咪唑類抗生素抗感染,必要時根據(jù)臨床癥狀、炎癥指標(biāo)、藥敏結(jié)果調(diào)整抗生素類型。
[Abstract]:Objective to analyze the clinical features and etiology of gastrointestinal perforation in neonates. Methods the general data, symptoms, signs, perforation, etiology, treatment and prognosis of 95 cases were summarized and analyzed. Results (1) the main clinical manifestations of 95 neonates with gastrointestinal perforation were abdominal distension (85 cases, 89.47%), vomiting (55 cases, 57.89%), abnormal body temperature in 31 cases (32.63%), abdominal bulge (85 cases, 89.47%), redness of abdominal wall (52 cases, 54.74%), abdominal vein irritation (44 cases, 46.32%). The location of the perforation was confirmed and identified, Perforation was located in the small intestine (45 cases, 47.37%), colon (40 cases, 42.11%), stomach (10 cases, 10.53%), ileum (33 cases, 73.33%) and transverse colon (11 cases, 27.50%); (3). The bacteria were cultured in 46 positive cases. Among the 53 strains of pathogenic bacteria, 40 strains (75.47%) were G- sex bacteria. Among them, Klebsiella pneumoniae pneumonia subspecies (15 strains, 37.5%) were detected most, followed by Escherichia coli (12 strains) and 30%); G (13 strains). There were 7 strains of Enterococcus faecium (53.85%), 3 strains of Staphylococcus epidermidis (23.08%), 2 strains of Enterococcus faecalis (15.38%); (4). The most common operation was enterostomy, the clinical cure rate was 82%, and the prognosis was good. (4) the whole body condition and perforation site of the children were analyzed comprehensively during the operation, with the aim of saving children's lives as the ultimate goal, a simple and effective operation was adopted. The most common operation is enterostomy, the clinical cure rate is 82%, and the prognosis is good. Conclusion the clinical manifestations of gastrointestinal perforation in neonates are atypical, abdominal distension with unknown causes accompanied with vomiting, fever and so on. Combined with abdominal examination, the possibility of gastrointestinal perforation should be alert, and pneumoperitoneum can be found by abdominal radiography. The most common pathogens were Gram-negative bacteria, among which Klebsiella pneumoniae and Escherichia coli were the most common. The third generation of semi-synthetic penicillin nitroimidazole antibiotics can be used to resist infection, and to adjust the types of antibiotics according to clinical symptoms, inflammatory indexes and drug sensitivity results.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R722.1

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