坏死性小肠结肠炎:文献综述

A. Hachem, J. Lyra, Eric W Scarpa, M. Bentlin
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摘要

目的:通过文献综述更新主题。方法:在MEDLINE、PubMed、SciELO、LILACS和Cochrane平台上检索相关主题的关键词,选择主要文章进行分析。结论:坏死性小肠结肠炎(NEC)是一种影响新生儿胃肠道(GIT)的炎症。修改后的贝尔分期标准根据临床和放射检查结果将其分为怀疑、确诊和晚期。发病机制尚不完全清楚。在足月婴儿中,由于肠系膜灌注不良而发生。经典形式发生在早产儿,具有多因素病理生理,包括:胃肠道发育不成熟、遗传易感性、肠道菌群变化、致病菌、肠内营养特点和缺氧缺血性肠损伤。所有这些因素都会激活强烈的炎症级联反应,从而导致肠道坏死。危险因素包括早产、低出生体重、败血症、动脉导管持续存在、贫血和/或输血等。除胃肠道症状(腹胀疼痛、胃残、呕吐、直肠出血)外,还有体温不稳、呼吸暂停、低血糖甚至休克等非特异性症状。x线检查可发现肠胀气、肺气肿、门静脉气体、气腹、腹膜内积液或持续扩张袢。治疗方法包括禁食、广谱抗生素、血流动力学监测。当出现临床恶化、穿孔或怀疑坏死时,需要手术治疗。预防措施包括:感染控制、母乳喂养、肠内营养的开始和进展方案以及益生菌的管理。
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Necrotizing enterocolitis: a literature review
OBJECTIVE: To update the topic through a literature review. METHODS: A search was performed on the MEDLINE, PubMed, SciELO, LILACS and Cochrane platforms, using keywords on the topic and, after selecting the main articles, they were analyzed. CONCLUSION: Necrotizing enterocolitis (NEC) is an inflammation that affects the gastrointestinal tract (GIT) of newborns. The modified Bell stagind criteria classifies it, according to clinical and radiographic findings, into suspicion, confirmed or advanced. Pathogenesis is not completely understood. In term babies it occurs due to poor mesenteric perfusion. The classic form occurs in preterm infants, with multifactorial pathophysiology that includes: immaturity of the GIT, genetic predisposition, changes in the intestinal microbiota, pathogenic bacteria, characteristics of enteral nutrition and hypoxic-ischemic intestinal injury. All of these factors activate an intense inflammatory cascade, which can lead to intestinal necrosis. Risk factors are prematurity, low birth weight, sepsis, persistence of the ductus arteriosus, anemia and/or transfusion, among others. In addition to gastrointestinal symptoms (abdominal distention and pain, gastric residuals, vomiting and rectal bleeding), it has nonspecific symptoms such as temperature instability, apneas, hypoglycemia or even shock. On radiographic examination, bowel distention, pneumatosis, portal vein gas, pneumoperitoneum, intraperitoneal fluid or persistent dilated loops are found. The therapeutic approach includes fasting, broad-spectrum antibiotics, hemodynamic monitoring. Surgery is indicated when clinical worsening, perforation or suspicion of necrosis occurs. Among the preventive measures are: infection control, breastfeeding, protocols for the initiation and progression of enteral nutrition and administration of probiotics.
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