CAJ | 학술논문

目的总结新生儿围产期肝脾出血的临床特点、诊治方法和预后.方法回顾分析1992年6月1日至2009年6月1日南京医科大学附属南京儿童医院新生儿内、外科收治的围产期肝脾出血新生儿的临床资料,分析病因、临床表现、治疗及预后情况.结果围产期肝脾出血新生儿共23例,其中巨大儿12例,早产儿6例.主要原因是异常分娩史(剖宫产、胎儿窘迫、产程延长、胎头吸引、急产等)和产伤,分别占65.2%(15/23)和47.8%(11/23).肝出血14例,脾出血6例,肝脾同时出血3例.早期主要临床表现包括反应差、嗜睡、拒乳者21例(91.3%),早期出现黄疸者18例(78.3%),苍白、贫血貌者17例(73.9%),腹胀者15例(65.2%),其他临床表现包括易激惹、呼吸困难、腹壁发紫、阴囊血肿等.保守治疗15例;手术治疗8例,其中死亡3例,病死率13.0%.结论新生儿围产期肝脾出血与巨大儿、早产儿及异常分娩史有关,以产伤为主要原因,临床表现与出血量有关,早期表现具有非特异性,超声是最好的诊断手段.血流动力学稳定的患儿保守治疗成功率高,出血不止者应尽早手术.
목적 총결신생인위산기간비출혈적림상특점、진치방법 화예후.방법 회고분석1992년6월1일지2009년6월1일남경의과대학부속남경인동의원신생인내、외과수치적위산기간비출혈신생인적림상자료,분석병인、림상표현、치료급예후정황.결과 위산기간비출혈신생인공23례,기중거대인12례,조산인6례.주요원인시이상분면사(부궁산、태인군박、산정연장、태두흡인、급산등)화산상,분별점65.2%(15/23)화47.8%(11/23).간출혈14례,비출혈6례,간비동시출혈3례.조기주요림상표현포괄반응차、기수、거유자21례(91.3%),조기출현황달자18례(78.3%),창백、빈혈모자17례(73.9%),복창자15례(65.2%),기타림상표현포괄역격야、호흡곤난、복벽발자、음낭혈종등.보수치료15례;수술치료8례,기중사망3례,병사솔13.0%.결론 신생인위산기간비출혈여거대인、조산인급이상분면사유관,이산상위주요원인,림상표현여출혈량유관,조기표현구유비특이성,초성시최호적진단수단.혈류동역학은정적환인보수치료성공솔고,출혈불지자응진조수술.
Objective To summarize the clinical characteristics,diagnosis and management methods and prognosis of hepatorrhagia and splenorrhagia of newborns.Methods A retrospective review of clinical data of neonates with hepatorrhagia and splenorrhagia in perinatal period was performed from June 1,1992 to June 1,2009 in Nanjing Children's Hospital.Results There were twenty-three neonates suffered from hepatorrhagia and splenorrhagia in the perinatal period.There were 12 macrosomias and 6 preterm newborns.Abnormal birth history (65.2%,15/23),including caesarean section,fetal distress,application of vacuum extractor,prolonged labour and precipitate labor,were most commom reasons of hepatorrhagia and splenorrhagia,and birth injuries [47.8% (11/23)]was subsequent.In all cases,14 cases were hepatorrhagia,six were splenorrhagia,three were hepatorrhagia and splenorrhagia simultaneously.Primary early symtoms included low response,sleepiness (91.3%,21/23);jaundice 78.3% (18/23);pallor and anemia 73.9% (17/23);abdominal distension (65.2%,15/23) and so on.Ultrasonography and computed tomography may make a definite diagnosis.Fifteen newborns underwent non-operative treatment and 8 received hemostatic laparotomy.The general mortality was 13.0%(3/23).Conclusions Hepatorrhagia and splenorrhagia of neonates in perinatal period is associated with macrosomias,abnormal birth history and preterm birth,and birth injuries were the major etiological factors.Clinical presentations are nonspecific which maybe asociated with the degree of blood loss.Abdominal ultrasonography is an optimal diagnostic method.Nonoperative management may be successful in hemodynamically stable patients,while immediate intervention,such as laparotomy,is required to control persist bleeding.