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追溯双中心观察性研究,比较极早产婴儿自发性肠孔的初级解剖或接与肠道解剖

Emeric Genet¹, Erasti Gounfle², Arnaud Bonnard³

¹Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Créteil, 40 Avenue de Verdun, 94000, Créteil, France.

European journal of pediatrics

|February 28, 2025

概括

对于具有自发性肠孔 (SIP) 的极早产婴儿,最初的一阶段手术涉及初级解或 suturing (PAS) 导致更短的腹腔营养 (PN) 持续时间和更少的全身麻醉手术相比肠静止术 (ES). 两种手术策略之间的长期结果是相似的.

科学领域:

新生儿手术新生儿手术
儿科外科手术儿科外科手术
胃肠道手术胃肠道手术

背景情况:

自发肠道穿孔 (SIP) 是极其早产和/或极低出生体重的婴儿的关键手术紧急情况.
对于SIP的最佳初始手术管理仍然是争论的主题.

研究的目的:

为了比较SIP的两个初始手术策略的结果:初级解或 suturing (PAS) 与肠静脉 (ES).

主要方法:

一项回顾性,双中心的观察性研究包括在怀孕28周之前出生和/或出生体重<1000克的婴儿,在2010-2020年期间为SIP进行了手术.
婴儿根据他们最初的外科手术进行分组:PAS或ES.
主要终点是亲肠道营养 (PN) 持续时间,使用多变量Cox模型进行分析. 二级终点包括手术重新干预,发病率和死亡率.

主要成果:

与ES组 (n=19) 相比,PAS组 (n=46) 的CRIB II分数更高,并且在特定的中心更频繁地进行手术.
在PAS组的婴儿中,PN断奶的概率显著更高 (调整后的危险比为3.05) 并且需要更少的全身麻醉程序 (中位数为1比2).
在分组之间,在出院或2岁时没有观察到结果的显著差异.

结论:

在使用PAS的极度早产婴儿中,SIP的初始单阶段手术与PN的持续时间缩短和更少的全身麻醉暴露有关.
在这种脆弱人群中,PAS可能是SIP的有利初步手术方法,而不会影响长期结果.

关键词:

总麻醉是一种全身麻醉.新生儿手术新生儿手术父母肠道营养是一种营养.

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