1岁以下小儿围术期早期死亡风险因素流行病学调查  

Epidemiological investigations of perioperative risk factors for early death in newborns and infants

作　　者：孔微微[1] 王孝庆[1] 王中苏[1] 万梦娇 解康杰[2] 谢作楷[1] 上官王宁[1] 连庆泉[1] 李军[1] 

机构地区：[1]温州医科大学附属第二医院麻醉科,浙江温州325027 [2]浙江省肿瘤医院麻醉科,浙江杭州310022

出　　处：《温州医科大学学报》2016年第1期44-47,共4页Journal of Wenzhou Medical University

基　　金：浙江省医药卫生平台骨干人才项目(2012ZDA036)

摘　　要：目的:研究1岁以下小儿围术期早期(≤3 d)死亡相关风险因素的临床流行病学特征。方法:遴选2011年至2013年温州医科大学附属第二医院76例新生儿及婴儿手术后死亡病例的临床资料,对其性别、出生孕周、年龄、出生体质量、术前体质量、术前是否存在合并症(心血管、呼吸、血液、肝肾等疾病)、术前意识状态、电解质紊乱情况、营养情况、美国麻醉医师协会(ASA)分级、手术部位、手术类型、手术持续时间、手术分级共15项可能的风险因素进行回顾性分析及统计学处理。结果:对新生儿及婴儿的出生体质量、术前合并呼吸系统疾病、ASA分级、意识状态与死亡时间行spearman秩相关分析,结果P值均小于0.05。以上4种风险因素经logistic逐步回归分析,只有术前合并呼吸系统疾病及麻醉ASA分级2个风险因素保留。受试者工作特征曲线(ROC)分析显示,与新生儿及婴儿围术期早期(≤3 d)死亡时间高度相关的风险因素是术前合并呼吸系统疾病(ROC曲线下面积为0.643)和麻醉ASA分级(ROC曲线下面积为0.694)。结论:术前合并呼吸系统疾病和麻醉ASA分级是新生儿及婴儿围术期早期死亡的有效预测因子,且ASA分级相对预测作用更强。Objective： To analyze clinical epidemiological characteristics with perioperative death associ-ated risk factors of children under 1 year of age in the early period （less than 3 days）. Methods： The clinical data from 76 cases of neonates and infants dead during perioperation from January 2011 to December 2013 were investigated in the Second Affiliated Hospital of Wenzhou Medical University. Retrospective analysis were conducted on their gender, gestational age, onset age, birth weight, preoperative weight, preoperative complications （such as cardiovascular disease, respiratory diseases, blood disorders, liver and kidney disease）, preoperative conscious state, electrolyte imbalance or not, the malnutrition or not, ASA classification, site of surgery, type of surgery, duration of surgery and operation classification. Results： Spearman rank correlation analysis was performed respectively among birth weight, preoperative respiratory disease, ASA classification grade and preopera- tive state of consciousness with death in early time. P value was lower than 0.05, according to P〈0.05 statistical standards, it had statistical significance. All the four risk fators above-mentioned entered into Logistic stepwise regression analysis, and finally only two risk factors （preoperative respiratory diseases and ASA classification） were reserved. From the area under the ROC curve analysis that neonates and infants during perioperative period of early （less than 3 days） time of death risk factors were highly correlated in preoperative respiratory disease （0.643）, ASA classification （0.694）. Conclusion： Preoperative respiratory disease and ASA classification are the effective predictor of perioperative early death in neonates and infants, and predictive value of ASA classification was stronger.

关 键 词：新生儿 婴儿 围术期死亡 风险因素 

分 类 号：R614.2[医药卫生—麻醉学]