目的 分析新生儿重症监护室(NICU)住院治疗的超未成熟儿(EPI,＜28 周)的临床特点及不良预后的危险因素,为临床治疗提供参考依据。方法 收集青岛妇女儿童医院NICU 2017年1月-2020年12月出院的124例EPI的临床资料进行回顾性分析。分析存活组(75例)和死亡组(49例)的相关因素,构建二元Logistic回归模型分析影响预后的相关因素。结果 124例患儿中,男67例(54.0%)。出生体重680～1 520 g,胎龄24+3～27+6周,总存活率60.5%。存活组和死亡组的出生体重、胎龄、双胎、产前应用糖皮质激素、使用肺表面活性物质、有创通气时长、无创通气、无创通气时长、总氧疗时长、并发新生儿呼吸窘迫综合征、脑室内出血、早发型败血症、新生儿坏死性小肠结肠炎比较,差异均有统计学意义(P＜0.05),多因素Logistic回归分析显示脑室内出血是影响预后的危险因素(OR=5.518,95%CI:1.186～25.685, P=0.029),无创通气是保护因素(OR=0.006,95%CI:0.001～0.051,P＜0.001)。结论 EPI的存活率不断提高,但与发达国家相比仍有一定差距。脑室内出血是影响EPI预后的重要危险因素。早期有效处理各种并发症,可提高EPI的存活率。
Abstract
Objective To analyze the risk factors of prognosis of extremely premature infants(EPI, ＜28 weeks) hospitalized in the Neonatal Intensive Care Unit (NICU) of Qingdao Women and Children's Hospital, in order to provide reference for the treatment.Methods Clinical data of 124 cases of EPI enrolled in the NICU of Qingdao Women and Children's Hospital from January 2017 to December 2020 were retrospectively analyzed. Differences between the survival (n=75) group and death group (n=49) were analyzed. Then binary Logistic regression model was established to analyze the risk factors for poor prognosis.Results Among 124 cases, 67 cases (54.0%) were male infants. The birth weight ranged from 680 g to 1 520 g, the gestational age ranged from 24+3 weeks to 27+6 weeks, and the overall survival rate was 60.5%.There were significant differences between the survival group and the death group in 13 indicators, including birth weight, gestational age, twins, antenatal corticosteroids, using pulmonary surfactant, invasive ventilation, non-invasive ventilation, duration of non-invasive ventilation, total oxygen therapy time, complicated with neonatal respiratory distress syndrome, intraventricular hemorrhage, early-onset sepsis, neonatal necrotizing enterocolitis (P＜0.05). Multivariate Logistic regression analysis showed intraventricular hemorrhage was risk factors for poor prognosis(OR=5.518, 95%CI:1.186 - 25.685,P=0.029),and non-invasive ventilation was protection factor(OR=0.006, 95%CI:0.001 - 0.051, P＜0.001).Conclusions The survival rate of EPI is improving, but there is still a gap from the developed countries. Intraventricular hemorrhage is an important risk factor for the prognosis of EPI. So it is suggested to treat complications effectively in early stage, thereby improving the survival rate of EPI.
关键词
存活率 /
超未成熟儿 /
无创通气
Key words
survival rate /
extremely premature infants /
non-invasive ventilation
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参考文献
[1] 邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].5版.北京:人民卫生出版社,2019.
[2] 早产儿治疗用氧和视网膜病变防治指南专家组.早产儿治疗用氧和视网膜病变防治指南[J].中华儿科杂志,2007,45(9):672-673.
[3] 《新生儿神经病学论坛》专家组.早产儿脑白质损伤诊断、防治与综合管理的专家组意见[J].中华新生儿科杂志,2015,30(3):175-177.
[4] 谢幸,孔北华,段涛.妇产科学[M].9版.北京:人民卫生出版社,2018.
[5] Myrhaug HT, Brurberg KG, Hov L, et al.Survival and impairment of extremely premature infants:A Meta-analysis[J]. Pediatrics,2019,143(2):58.
[6] Su BH, Hsieh WS, Hsu CH, et al. Neonatal outcomes of extremely preterm infants from Taiwan:Comparison with Canada, Japan, and the USA[J]. Pediatr Neonatol,2015, 56(1):46-52.
[7] 中华医学会儿科学分会新生儿学组.中国城市早产儿流行病学初步调查报告[J].中国当代儿科杂志,2005,7(1):25-28.
[8] Stoll BJ, Hansen NI, Bell EF, et al. Neonatal outcomes of extremely preterm infants from the NICHD neonatal research network[J].Pediatrics,2010,126(3):443-456.
[9] 超未成熟儿与超低出生体重儿研究协作组.广东省超未成熟儿与超低出生体重儿临床救治分析[J].中华儿科杂志,2019,57(12):934-942.
[10] 超未成熟儿与超低出生体重儿研究协作组.广东省26家三甲医院新生儿科超未成熟儿与超低出生体重儿的住院费用分析[J].实用医学杂志,2020,36(1):108-114.
[11] Ma L, Liu CQ, Cheah I, et al. Cost is an important factor influencing active management of extremely preterm infants[J]. Acta Paediatr, 2019, 108(1):70-75.
[12] 霍乐颍,黄辉文.超低出生体质量儿与超未成熟儿的临床特点及预后影响因素分析[J].当代医学,2020,26(29):95-98.
[13] 超未成熟儿与超低出生体重儿研究协作组.超未成熟儿与超低出生体重儿临床救治结局分析[J].中华新生儿科杂志,2020,35(2):108-112.
[14] Sweet DG, Carnielli V, Greisen G, et al. European consensus guidelines on the management of respiratory distress syndrome 2019 update[J]. Neonatology, 2019, 115(4):432-450.
[15] 李科纯,钱素云,曾健生.肺表面活性物质治疗急性呼吸窘迫综合征研究现状[J].中国实用儿科杂志,2018,33(6):431-434.
[16] Sardesai S, Biniwale M, Wertheimer F, et al. Evolution of surfactant therapy for respiratory distress syndrome: past, present, and future[J]. Pediatr Res,2017,81(1-2):240-248.
[17] 迟明,梅亚波.新生儿急性呼吸窘迫综合征研究进展[J].中国当代儿科杂志,2018,20(9):724-728.
[18] 超未成熟儿与超低出生体重儿研究协作组.超未成熟儿与超低出生体重儿产前糖皮质激使用情况及其对预后影响的多中心调查[J].中国围产医学杂志,2020,23(5):302-310.
[19] 唐思,高喜容,吴运芹.早产儿颅内出血的危险因素及预防进展[J].中华新生儿科杂志,2020,35(1):65-68.
[20] Su BH, Lin HY, Huang FK, et al. Circulatory management focusing on preventing intraventricular hemorrhage and pulmonary hemorrhage in preterm infants [J]. Pediatr Neonatol, 2016,57 (6):453-462.
[21] 崔银珠,张谦慎,贺红云,等.超未成熟儿的生存状况与预后影响因素分析[J].中国当代儿科杂志,2014,16(6):596-600.
[22] 林颖仪.早产儿脑损伤影像学及脑电图诊断的研究进展[J].临床儿科杂志,2017,35(7):548-552.
基金
青岛市卫生科技发展计划项目(2019-WJZD129)
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