超早产儿出院时临床结局及影响因素分析  

Clinical outcome at discharge and its risk factors of extremely preterm infants： a study of 179 cases

作　　者：庄严[1] 高喜容[1] 刘新晖[1] 吴运芹[1] 熊月娥[1] 李强[1] 刘雨[1] 张琼[1] 

机构地区：[1]湖南省儿童医院新生儿科,长沙410007

出　　处：《中国新生儿科杂志》2017年第2期86-90,共5页Chinese Journal of Neonatology

基　　金：湖南省卫生计生委科研项目（C2015-058）

摘　　要：目的 分析超早产儿出院时的临床结局及其影响因素.方法 回顾性分析我院2008年9月至2014年8月收治的超早产儿临床资料,分析患儿出院时的临床结局及其高危因素.结果 共179例超早产儿纳入研究,存活率59.2％（106/179）,不良临床结局发生率74.3％ （133/179）.133例不良临床结局患儿中73例死亡,死亡原因分别为重度支气管肺发育不良28例,Ⅲ～Ⅳ度颅内出血19例,败血症16例,Ⅲ期坏死性小肠结肠炎6例,其他4例;另外60例为存活但出院时存在严重疾患,其中严重神经系统或眼部疾患35例,严重肺部疾患25例.单因素分析显示,不良结局组产前未使用激素、胎盘早剥、男性、小于胎龄儿、需要胸外心脏按压复苏、入院日龄＞72 h、重度新生儿呼吸窘迫综合征、未应用肺表面活性物质、机械通气时间＞2周、败血症的比例均高于治愈组,差异有统计学意义（P＜0.05）.Logistic回归分析显示,产前未使用激素（OR=9.402,P=0.002）、小于胎龄儿（OR=8.271,P=0.018）、需要胸外心脏按压复苏（OR=6.325,P=0.023）、入院日龄＞72 h（OR=4.174,P=0.028）是超早产儿出院时不良临床结局的独立危险因素.结论 超早产儿出院时不良临床结局发生率高,避免小于胎龄儿、及时合理的宫内及出生后转运、产前使用激素可改善其出院临床结局.Objective To analysis the clinical outcome at discharge and its risk factors of extremely preterm infants.Method To retrospectively analysis the clinical outcome at discharge and it＇s risk factors of extremely preterm infants （less than 28 weeks gestation） admitted from September 2008 to August 2014 in our Hospital.Result A total of 179 cases were enrolled.Survival rate was 59.2% （106/179）.Unfavorable outcome rate was 74.3% （133/179）,among them 73 cases died.The top five causes of death were severe bronchopulmonary dysplasia （BPD） （28 cases）,Ⅲ ～ Ⅳ o intraventricular hemorrhage （IVH） （19 cases）,sepsis （16 cases） and necrotizing enterocolitis （NEC） （6 cases）.Among the 60 survivals with unfavorable outcomes,35 cases had either severe neurologic or ophthalmological sequela,and 25 cases had severe pulmonary sequela.Univariate analysis showed that,comparing with improved group,unfavorable outcome group had higher rates of not receiving prenatal steroids,placental abruption,male,small for gestation age,resuscitation with chest compression,admission age older than 72 hour,severe respiratory distress syndrome （RDS）,without pulmonary surfactant （PS） usage,mechanical ventilation beyond 2 weeks and sepsis （P 〈 0.05）.Logistic regression analysis showed that those without prenatal steroids （OR =9.402,P =0.002）,small for gestational age （OR =8.271,P =0.018）,resuscitation with chest compression （OR =6.325,P =0.023）,admission age older than 72 hour （OR =4.174,P =0.028） were independent risk factors for unfavorable outcome of extremely premature at discharge.Conclusion Extremely preterm infants have a higher rate of unfavorable outcome at discharge.Avoid small for gestational age,transfer properly and in time both in utero and after birth,and conduct prenatal steroids could improve their clinical outcome at discharge.

关 键 词：婴儿 早产 预后 危险因素 回顾性研究 超早产儿 

分 类 号：R722.6[医药卫生—儿科]