背景:尽管坏死性小肠结肠炎或自发性肠穿孔引起的气腹是外科急症,缺乏风险分层来确定哪些新生儿从初次腹膜引流(PD)中受益。
方法:对因坏死性小肠结肠炎或自发性肠穿孔而因气腹(2015年1月至2023年12月)接受PD的1500g以下极低出生体重新生儿进行单中心回顾性研究,我们创建了两个队列:引流\"应答者\"(明确接受PD治疗的患者;包括放置第二个引流者)和\"无反应者\"(接受随后剖腹手术或PD后死亡的患者).产前/产后特征,围手术期临床数据,使用学生t检验比较响应者和无响应者之间的医院结果,卡方检验,或者Kruskal-Wallis测试,P<0.05被认为是显著的。
结果:56例新生儿被纳入:31例(55%)引流反应者和25例(45%)无反应者。出生体重,胎龄,性别,种族,使用产后类固醇,两组之间的肠内喂养相似。无反应者在引流后具有更高的碱基缺陷(-3.4对-5.0,P=0.032)和FiO2(0.25对0.52,P=0.001)。排水反应者的住院时间明显较短(89天对148天,P=0.014)和较低的死亡率(6.4%对56%,P<0.001)。对无反应者的亚组分析显示出生体重没有差异,血管加压药的要求,FiO2,或单独引流与引流后剖腹手术的无反应者之间的引流后基差。
结论:PD仍然是早产极低出生体重新生儿(<1500g)气腹的可行初始疗法,超过一半的临床反应。引流管放置后,必须进行持续的临床评估和判断,以确保持续的临床改善。
BACKGROUND: Although pneumoperitoneum from necrotizing enterocolitis or spontaneous intestinal perforation is a surgical emergency, risk stratification to determine which neonates benefit from initial peritoneal drainage (PD) is lacking.
METHODS: Using a single-center retrospective review of very low birth weight neonates under 1500 g who underwent PD for pneumoperitoneum (January 2015 to December 2023) from necrotizing enterocolitis or spontaneous intestinal perforation, two cohorts were created: drain \"responders\" (patients managed definitively with PD; includes placement of a second drain) and \"nonresponders\" (patients who underwent subsequent laparotomy or died after PD). Antenatal/postnatal characteristics, periprocedural clinical data, and hospital outcomes were compared between responders and nonresponders using Student\'s t-test, chi-squared test, or Kruskal-Wallis test as appropriate, with P < 0.05 considered significant.
RESULTS: Fifty-six neonates were included: 31 (55%) drain responders and 25 (45%) nonresponders. Birth weight, gestational age, sex, ethnicity, use of postnatal steroids, and enteral feeds were similar between the cohorts. Nonresponders had higher base deficits (-3.4 versus -5.0, P = 0.032) and FiO2 (0.25 versus 0.52, P = 0.001) after drain placement. Drain responders had significantly shorter lengths of stay (89 versus 148 days, P = 0.014) and lower mortality (6.4% versus 56%, P < 0.001). A subgroup analysis of the nonresponders showed no differences in birth weight, vasopressor requirement, FiO2, or postdrain base deficit between nonresponders who had a drain alone versus laparotomy following drain placement.
CONCLUSIONS: PD remains a viable initial therapy for pneumoperitoneum in premature very low birth weight neonates (< 1500 g), demonstrating clinical response in more than half. Ongoing clinical assessment and judgment is imperative after drain placement to ensure continued clinical improvement.