经转诊入院危重新生儿死亡病例分析  

An analysis of death cases from regional critical newborn transfer system

作　　者：王凤[1] 屈素清[1] 郑晓燕[1] 刘卫鹏[1] WANG Feng;QU Su-qing;ZHENG Xiao-yan;LIU Wei-peng(Pediatric Department of Navy General Hospital of PLA, Beijing 100048, China)

机构地区：[1]中国人民解放军海军总医院儿科,北京100048

出　　处：《中国急救复苏与灾害医学杂志》2018年第4期341-344,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：国家重点研发计划（2017YFA010）

摘　　要：目的分析近4年内转诊入院的新生儿死亡病例，分析危重转诊新生儿病例特点及高危因素及死亡原因。方法对2013年3月-2017年3月转诊入院并死亡的17例病例进行回顾性分析。比较因“重度窒息”转诊入院13例死亡及21例存活病例两组间Apgar评分、生后第一次血气分析、复苏措施、凝血功能、休克发生率、意识障碍发生率、惊厥发生率、转诊小组到场时问。结果①死亡病例入院诊断以新生儿窒息为主。死亡原因主要为窒息脑损伤、先天性疾病、早产儿经济困难导致放弃治疗。妊娠合并症主要为妊娠期糖尿病、高血压、呼吸道感染；②重度窒息转诊新生儿：5min及10min Apgar评分、生后第一次pH值死亡组低于存活组；胸外按压、肾上腺素使用、休克、意识障碍及惊厥发生率，死亡组均高于存活组；转诊小组到场时间死亡组长于存活组。结论①新生儿窒息及其相应并发症为转诊主要死亡原因；②重度窒息复苏后应保证有效循环、积极纠酸、监测凝血功能；③需加强产院窒息复苏技术培训，高危分娩应提前通知转会诊单位到场协助；④对无窒息患儿生后早期呼吸困难应提高重视；⑤应加强妊娠期血糖血压控制及先天疾病宫内筛查，关注宫内羊水减少；⑥增加社会对极低、超低早产儿经济及护理援助。Objective To investigate the causes, characteristic information and risk factors of death cases from regional critical newborn transfer system. Methods The clinical records of 17 death bases cases from transfer system between 2013.3 and 2017.3 were collected and analyzed.13 death cases and 21 survival cases diagnosed with serious asphyxia were compared in Apgar Scores in 5 and 10 minutes after birth,the first blood gas analysis after birth,resuscitation strategies,coagulation function, rate of shock and neural system manifestation,time for transfer team. Results 1.The first transferring reason was asphyxia_The main causes of death was withholding treatment because of asphyxia, congenital disease,and economic difficulty of preterm.Gestational diabetes mellitus and hypertension were top two pregnancy complication.2.In the asphyxia subteam,the death cases had lower Apgar Scores in 5 and 10 minutes after birth,lower pH value,worse coagulation,higher shock rate,longer waiting for transferring and needed more intensive resuscitation. Conclusions Asphyxia with complications was the main causes of neonatal death. The severe asphyxia infants need appropriate correction of acidosis, supplement of fluid for circulation and serum to improve coagulation after adequate resuscitation. The resuscitation skills for asphyxia should be trained periodically. It will be safer for patients that the transfer team arrive before the risky delivery .Respiratory distress in the first hour after delivery of infants without asphyxia also cannot be ignored.Managements of hyperglycemia and hypertension during the pregnancy need more critical interventions.Fetals with decrease of amniotic fluid maybe have risk of asphyxia and congenital disease.Extreme preterm need more social support especially in financial and nursing aspects.

关 键 词：患者转诊 死亡原因 窒息 新生儿 

分 类 号：R720.597[医药卫生—急诊医学]