目的 分析早产小于胎龄儿(SGA)与适于胎龄儿(AGA)高危因素、发病情况的差异,为早产SGA进行临床干预提供依据。方法 选取2011年l月-2017年12月昆明医科大学第一附属医院新生儿科收治的1 370例早产儿为研究对象,根据胎龄与出生体重的关系分为SGA组(675例)与AGA组(695例),比较两组早产儿的一般情况、围生期高危因素及并发症情况。结果 1)SGA组出生体重、出生身长、出生头围、出院体重、出院身长均小于AGA组,住院天数较AGA组长,差异均有统计学意义(χ² =-11.62、-7.12、-5.25、-5.72、-2.1、4.46,P＜0.05);2)SGA组其母系高龄产妇、妊娠高血压综合征、胎盘异常、剖宫产与AGA组相比较差异均有统计学意义(t=65.841、170.937、19.558、92.719,P＜0.05);3)早产SGA组并发窒息、新生儿呼吸窘迫综合征、心肌损伤、喂养不耐受、肺炎、败血症、低血糖、低甲状腺素血症的比例高于AGA组,差异均有统计学意义(t=4.465、4.162、6.035、3.97、5.180、5.21、4.71、5.031,P＜0.05);4)Logistic 回归分析显示:母亲患妊娠期高血压(OR=5.64,95%CI:1.28~16.16)、胎盘异常(OR=3.65,95%CI:1.16~7.69)、多胎妊娠(OR=2.89,95%CI:1.05~8.84)是早产SGA发生的独立危险因素。结论 加强孕期保健、胎儿宫内监测,及时发现胎儿宫内生长发育迟缓,对孕母进行积极治疗,有助于减少早产SGA的发生;加强早产SGA的监护治疗,可降低其并发症的发生。

Objective To investigate the risk factors of pretermsmall for gestational age (SGA) and appropriate for gestational age (AGA),and to provide basis for clinical intervention in preterm SGA. Methods A total of 1 370 preterm infants admitted to the First Affiliated Hospital of Kunming Medical University from January 2011 to December 2017 were enrolled. The relationship between gestational age and birth weight was divided into SGA group (675 cases) and AGA group (695 cases). The general situation of premature infants in the two groups,perinatal high risk factors and complications were compared. Results 1) Birth weight,birth length,birth head circumference,discharge weight,discharge length of SGA group were less than those of AGA group.Hospitalization days in SGA group were longer than that in AGA group,the difference was statistically significant (χ² =-11.62、-7.12、-5.25、-5.72、-2.1、4.46,P<0.05);2)There were significant differences between SGA group and AGA group in maternal age maternal,pregnancy-induced hypertension syndrome,placental abnormality,cesarean section (t=65.841,170.937,19.558,92.719,P＜0.05); 3) The incidence of asphyxia,neonatal respiratory distress syndrome,myocardial injury,feeding intolerance,pneumonia sepsis,hypoglycemia and hypothyroxinemia in preterm SGA group were signigicantly higher than that in AGA group (t=4.465、4.162、6.035、3.97、5.180、5.21、4.71、5.031,P＜0.05);4) Logistic regression analysis indicated that the mother with gestational hypertension (OR=5.64,95%CI:1.28-16.16),placental abnormality (OR=3.65,95%CI:1.16-7.69),multiple pregnancy (OR=2.89,95%CI:1.05-8.84) were independent risk factors for the occurrence of premature SGA. Conclusion Strengthening pregnancy health care,intrauterine monitoring,timely detection of intrauterine growth retardation,active treatment of pregnant mothers can help reduce the incidence of premature SGA; strengthening the monitoring of premature delivery of SGA can reduce the occurrence of complications.