摘要
目的 探讨脐膨出的临床特征,评估脐膨出不良结局的相关危险因素.方法 回顾性队列研究,收集2013年1月至2022年12月在浙江大学医学院附属儿童医院因脐膨出住院治疗的224例患儿临床资料.根据患儿出院时状况分为预后良好及预后不良2组,采用x2检验、连续校正x2检验、Fisher确切概率法、Mann-Whitney U检验比较两组患儿的疾病特点及诊治情况.通过Logistic回归分析寻找与脐膨出不良结局相关的危险因素.结果 224例脐膨出患儿中男126例,208例(92.9％)预后良好,16例(7.1％)预后不良.预后不良组患儿中巨型脐膨出14例,预后良好组患儿中巨型脐膨出100例.预后不良组疝囊中疝入2个以上腹腔脏器、合并心脏畸形、动脉导管未闭、肺动脉高压、败血症、疝囊表面感染的比例均高于预后良好组(均P＜0.05).预后不良组患儿有创机械通气、氧疗应用、静脉营养应用和总住院时间均长于预后良好组,出现静脉营养相关胆汁淤积的比例高于预后良好组(均P＜0.01).多因素Logistic回归分析显示,肺动脉高压(OR=9.39,95％CI 1.20～73.32)、败血症(OR=8.59,95％CI 1.32～55.86)、合并心脏畸形(OR=6.55,95％CI 1.11～38.73)均为脐膨出不良结局的独立危险因素(均P＜0.05).结论 脐膨出易合并心脏畸形、败血症、肺动脉高压等,不良结局的危险因素包括肺动脉高压、败血症及合并心脏畸形.
Abstract
Objective To investigate the clinical characteristics of omphalocele,and to assess the risk factors associated with adverse outcomes.Methods A retrospective cohort study was conducted.Clinical data of 224 patients diagnosed with omphalocele,who were hospitalized at Children's Hospital,Zhejiang University School of Medicine from January 2013 to December 2022,were collected.Based on their discharge outcomes,the patients were classified into 2 groups:favorable outcomes and unfavorable outcomes.x2 test,continuity correction x2 test,Fisher exact probability method,and Mann-Whitney U test were used for intergroup comparisons.Logistic regression analysis was performed to identify risk factors associated with adverse outcomes in omphalocele.Results Among the 224 patients with omphalocele,126 were male.A total of 208 patients(92.9％)had favorable outcomes,while 16 patients(7.1％)had unfavorable outcomes.In the unfavorable outcomes group,14 patients had giant omphaloceles,while 100 patients had giant omphaloceles in the favorable outcomes group.The rates of herniation of more than 2 intra-abdominal organs in the hernial sac,congenital heart defects,patent ductus arteriosus,pulmonary hypertension,sepsis and infection of the hernial sac,were all higher in the unfavorable outcomes group compared to the favorable outcomes group(all P＜0.05).Patients with unfavorable outcomes had longer mechanical ventilation time,duration of oxygen use,duration of parenteral nutrition,hospital stays,and higher rates of parenteral nutrition-associated cholestasis compared to those with favorable outcomes(all P＜0.01).Multivariate Logistic regression analysis indicated that pulmonary hypertension(OR=9.39,95％CI 1.20-73.32),sepsis(OR=8.59,95％CI 1.32-55.86),and congenital heart defects(OR=6.55,95％CI 1.11-38.73)were all independent risk factors for adverse outcomes in omphalocele(all P＜0.05).Conclusions Infants with omphalocele are prone to complications such as cardiovascular malformations,infections,and pulmonary hypertension.Adverse outcomes in omphalocele are associated with pulmonary hypertension,sepsis,and congenital heart defects.
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