Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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괴사성 장염으로 수술한 초극소저체중출생아(<1,000 g)의 예후인자 분석

Analysis of prognostic factors of laparotomy for necrotizing enterocolitis in extremely low birth weight infants

  • 김진규 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 김이선 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 유혜수 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 안소윤 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 서현주 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 최서희 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 박수경 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 정유진 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 김묘징 (동아대학교 의과대학 소아과학교실) ;
  • 전가원 (인제대학교 의과대학 부산백병원 소아청소년과) ;
  • 구수현 (마산삼성병원 소아청소년과) ;
  • 이경훈 (성균관대학교 의과대학 분자세포생물학교실) ;
  • 장윤실 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 박원순 (성균관대학교 의과대학 삼성서울병원 소아청소년과)
  • Kim, Jin Kyu (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Yi Sun (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yoo, Hye Soo (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Ahn, So Yoon (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Seo, Hyun Ju (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Seo Heui (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Soo Kyung (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jung, Yu Jin (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Myo Jing (Department of Pediatrics, Dong-A University College of Medicine) ;
  • Jeon, Ga Won (Department of Pediatrics, Inje University College of Medicine, Busan Paik Hospital) ;
  • Koo, Soo Hyun (Department of Pediatrics, Masan Samsung Hospital) ;
  • Lee, Kyung-Hoon (Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine) ;
  • Chang, Yun Sil (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Won Soon (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 투고 : 2009.09.15
  • 심사 : 2009.12.04
  • 발행 : 2010.02.15
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초록

목 적 : ELBWI의 생존률의 괄목할 만한 향상과 더불어 괴사성 장염으로 수술 받는 건수가 증가하고 있다. ELBWI 사망의 중요한 원인인 괴사성 장염으로 수술한 1,000 g 미만 환아의 예후인자에 대해 확인해 보고자 하였다. 방 법 : 2001년부터 2008년까지 삼성서울병원 신생아 집중치료실에서 괴사성 장염으로 수술 받은 1,000 g 미만 환아 35명을 대상으로 개복술 후 생존군(n=28명)과 사망군(n=7명)의 임상적 특성 및 수술관련 인자들을 후향적으로 조사하였다. 결 과 : ELBWI 출생 환아 408명 중 35명(생존군 28명, 사망군 7명)이 괴사성 장염으로 개복술을 받았고 20%의 환아가 사망하였다. 수술 전 SNAP-II 점수($8{\pm}10$점 vs. $20{\pm}17$점; P = 0.022), 흡입산소농도($0.3{\pm}0.1$ vs. $0.7{\pm}0.4L/min$ ; P <0.001)는 생존군에서 사망군에 비해 유의하게 낮았고, 염기과잉은($-3{\pm}7$ vs. $-11{\pm}8$; P =0.004) 사망군에서 유의하게 낮았다. 수술 전과 후의 맥박수, 호흡수, 평균혈압 등 활력지수와 혈액가스 검사상 수소이온농도지수, 이산화탄소 농도, 칼륨은 두 군간 유의한 차이가 없었다. 수술 중 수액 투여량($14{\pm}4$ vs. $11{\pm}4mL/kg/hr$; P =0.045)이 생존군에서 유의하게 높았으나 수술 후 수액 투여량($184{\pm}36$ vs. $266{\pm}173mL/kg/day$; P =0.022)은 사망군에서 유의하게 높았다. 결 론 : 괴사성 장염으로 수술 받은 ELBWI를 대상으로 생존군과 사망군을 비교해보았을 때 양호한 예후인자로 수술 전 안정된 전신상태, 수술 중 충분한 수액의 투여, 그리고 수술 후 안정된 혈역학적 상태가 관련이 있었다.

Purpose : With improved survival of extremely low birth weight infants (ELBWI), there is an increase in the incidence of necrotizing enterocolitis (NEC) requiring laparotomy, and the risk of morbidity and mortality in these ELBWI is increased. Thus, we determined the prognostic factors in ELBWI who underwent laparotomy for NEC. Methods : We retrospectively reviewed the medical records of 35 ELBWI who underwent laparotomy for NEC from January 2001 to December 2008 at Samsung Medical Center. Results : Of 480 ELBWI, 35 required laparotomy for NEC; the mortality rate was 20% (Alive group n=28, Dead group n=7). The values of preoperative score for neonatal acute physiology-II (P =0.022) and fraction of inspired oxygen (P <0.001) were significantly higher in the dead group and values of base excess (P =0.004) were significantly lower in the dead group. Values of preoperative heart rate, respiration rate, mean blood pressure, pH, $CO_2$, and potassium ion were not significantly different between the study groups. Intraoperative fluid volume was significantly higher in the alive group than in the dead group (P =0.045). Postoperative infusion rate was significantly lower in the alive group than in the dead group (P =0.022). Conclusion : Good preoperative condition, more intraoperative fluid infusion, and stable postoperative hemodynamic condition were factors associated with favorable prognosis of laparotomy for NEC in ELBWI.

키워드

참고문헌

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피인용 문헌

  1. Analysis of Neonatal Gastrointestinal Diseases in a Neonatal Intensive Care Unit for 3 Years Neonatal GI Diseases in a NICU for 3 Years vol.18, pp.2, 2010, https://doi.org/10.5385/jksn.2011.18.2.337
  2. Presentation Time of Necrotizing Enterocolitis Diagnosed by Sonography according to Gestational Age vol.22, pp.1, 2015, https://doi.org/10.5385/nm.2015.22.1.21