臺灣博碩士論文加值系統

本研究目的在探討極低體重早產兒罹患壞死性腸炎之相關因素及其重要的預測因子。採病歷回溯性研究設計，收集時間自100年01月1日至110年12月31日期間於南部某區域教學醫院，出生週數小於37週且出生體重小於1500公克且已開始進食之新生兒檔案，共收集232人。使用SPSS 20.0統計套裝軟體進行分析。研究對象平均週數為28.11±2.59週，平均出生體重為1157.97±238.81公克；卡方檢定及Mann-Whitney U檢定顯示與罹患壞死性腸炎有顯著意義的變項，包括新生兒因素中出生體重及住院天數、母親因素以妊娠合併高血壓與餵食因素為餵食至足量天數。經由Logistic迴歸分析，新生兒因素中出生體重每增加一公克，研究對象會產生壞死性腸炎的風險為0.996倍。母體因素中發現母親有妊娠合併高血壓，早產兒發生壞死性腸炎的風險較低，有妊娠合併高血壓者是無妊娠合併高血壓者的0.157倍。餵食因素中發現進食足量天數每增加一天，研究對象會產生壞死性腸炎的風險為1.058倍。本研究提供新生兒加護病房照護人員對極低體重早產兒罹患壞死性腸炎之危險因素有更深入了解，並運用於預防及提早診斷出壞死性腸炎。

The purpose of this study is to investigate the risk factors for necrotizing enterocolitis (NEC) in very low birth weight (VLBW) preterm infants. A retrospective study design was employed, collecting data from medical records of newborns born in a regional teaching hospital in southern Taiwan from January 1, 2011 to December 31, 2021. The inclusion criteria were infants with a gestational age of less than 37 weeks; a birth weight of less than 1500 grams; and have begun feeding, resulting in a total of 232 cases. Statistical analysis was conducted using SPSS 20.0 software. The mean gestational age of the study subjects was 28.11 ± 2.59 weeks, and the mean birth weight was 1157.97 ± 238.81 grams. Among them, 34 infants (14.66%) were diagnosed with NEC, and one infant died from NEC.
Chi-square and Mann-Whitney U test revealed that birth weight and length of hospital stay were significant neonatal factors associated with NEC. Among maternal factors, pregnancy-induced hypertension was significant. In terms of feeding factors, the duration of full enteral feeding showed a significant association with NEC. Logistic regression analysis demonstrated that for every 1-gram increase in birth weight, the risk of developing NEC in the study subjects reduced to a factor of 0.996. Among maternal factors, it was found that pregnancy-induced hypertension (PIH) was associated with a lower risk of NEC in VLBW preterm infants, with a risk ratio of 0.157 compared to those without maternal PIH. In terms of feeding factors, for each additional day of full enteral feeding, the risk of developing NEC in the study subjects increased to 1.058 times.
This study provides caregivers in the neonatal intensive care unit with valuable information on the risk factors associated with NEC in VLBW preterm infants. Our results may be utilized as a reference for the prevention and early diagnosis of NEC, with the ultimate goal of improving the quality of clinical care in NICU.

中文摘要……………………………………………………………Ⅰ
英文摘要……………………………………………………………Ⅱ
致謝…………………………………………………………………Ⅲ
內容目錄……………………………………………………………Ⅳ
圖表目錄……………………………………………………………Ⅶ
第一章 緒論……………………………………………………….1
第一節 問題背景及重要性…………………………………….1
第二節 研究問題……………………………………………….3
第三節 研究目的……………………………………………….4
第二章 文獻查證與概念架構…………………………………….5
第一節 早產兒的定義、盛行率與特性……………………….5
第二節 壞死性腸炎……………………………………………10
第三節 壞死性腸炎的相關因素………………………………13
第四節 研究架構………………………………………………28
第五節 名詞定義………………………………………………29
第三章 研究方法…………………………………………………31
第一節 研究設計與研究情境/場所…………………………...31
第二節 研究樣本及取樣………………………………………32
第三節 資料收集……………………………..............................33
第四節 研究倫理考量…………………………………………..36
第五節 資料分析方法…………………………………………..37
第四章 研究結果…………………………………………………..39
第一節 研究對象基本屬性之描述……………………………..39
第二節 研究變項與壞死性腸炎之差異分析…………………..46
第三節 極低體重早產兒與壞死性腸炎之重要預測因子……..51
第五章 討論………………………………………………………..53
第一節 極低體重早產兒罹患壞死性腸炎的基本資料………..53
第二節 極低體重早產兒罹患壞死性腸炎之新生兒因素……..55
第三節 極低體重早產兒罹患壞死性腸炎之母體因素………..56
第四節 極低體重早產兒罹患壞死性腸炎之餵食狀況………..57
第六章 結論與建議………………………………………………. 59
第一節 結論……………………………………………………..59
第二節 建議……………………………………………………..61
第三節 研究限制………………………………………………..63
參考文獻…………………………………………………………....64
中文部分…………………………………………………………64
英文部分…………………………………………………………65
附錄
附錄一 極低體重早產兒病歷摘要……………………………74
附件二 人體試驗委員會同意書………………………………76

 
圖表目錄

表1 壞死性腸炎分期……………………………………………...11
圖1 研究架構………………………………………………………28
圖2 研究收案流程圖………………………………………………35
表2 極低體重早產兒的基本屬性…………………………………40
表3 極低體重早產兒之母親因素…………………………………41
表4 極低體重早產兒之餵食狀況…………………………………42
表5 極低體重早產兒併發壞死性腸炎的狀況……………………43
表6 常態分佈檢定…………………………………………………44
表7不同分級壞死性腸炎之極低體重早產兒出生週數跟母親年齡之比較………………………………………………………………….45
表8 是否罹患壞死性腸炎的極低體重早產兒之新生兒因素差異分析…………………………………………………………………….47
表9 是否罹患壞死性腸炎的極低體重早產兒之母親因素差異分析
……………………………………………………………………….48
表10 是否罹患壞死性腸炎的極低體重早產兒之餵食狀況差異分析
……………………………………………………………………… 50
表11 顯著關係變項對壞死性腸炎之共線性診斷…………….… 51
表12 極低體重早產兒罹患壞死性腸炎的Logistic迴歸分析….. 52

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