晚期早产儿从子宫内到子宫外环境过渡的研究  

Research of the transition from intra to extra-uterine environment of late preterm infant

作　　者：谢露 张铮[1] 孙立平[1] 刘玉明 底建辉[1] XIE Lu;ZHANG Zheng;SUN Liping;LIU Yuming;DI Jianhui(DeparLmenL of PediaLrics,Daxing HospiLal AffiliaLed Lo CapiLal Medical UniversiLy,Beijing 102600,China)

机构地区：[1]首都医科大学大兴医院儿科,北京102600

出　　处：《中国医药导报》2018年第20期74-78,共5页China Medical Herald

基　　金：首都医科大学大兴医院科技项目(4201807210)

摘　　要：目的评估晚期早产的高危因素、晚期早产儿(LPIs)的复苏和低体温风险,并探讨LPIs过渡期并发症。方法采用回顾性队列研究的方法,选择首都医科大学大兴医院连续分娩的268例LPIs,按胎龄分成3组:34周组60例,35周组75例,36周组133例。统计分析孕母因素、分娩因素和新生儿因素的数据,观察两组产房复苏、新生儿出生时(T1)及生后2 h(T2)的体温。结果 70例(26.1%)LPIs有孕母妊娠期并发症,34周组先兆子痫和肝内胆汁淤积症发生率显著高于35周组和36周组(均P<0.05);47例(17.5%)LPIs有通气复苏,36例(13.4%)需氧气复苏(面罩或气管插管),34周组通气复苏率显著高于35周组和36周组,差异均有统计学意义(P<0.05);不同胎龄及孕母产前类固醇治疗、自发性早产、剖宫产及先兆子痫情况患儿通气复苏率比较,差异有统计学意义(P<0.05);胎龄是LPIs氧气复苏的独立危险因素(P<0.05);从T1到T2,34周组正常体温的新生儿比率显著低于35周组和36周组,34周组LPIs的呼吸系统疾病发生率和新生儿重症监护室(NICU)入院率显著高于35周组和36周组,差异均有统计学意义(P<0.05)。结论 LPIs的胎龄越小,尤其34周组胎龄儿,孕母妊娠期并发症越多,产房复苏和低体温的风险越大,呼吸系统疾病发生率和NICU入院率越高,过渡到子宫外环境的难度就越大,需要在出生时予以充分的靶向管理。Objective To evaluaLe Lhe risk facLors of laLe preLerm infanLs(LPIs),recovery and hypothermia of LPIs,and Lo explore Lhe complicaLions of LransiLion of LPIs.Methods The reLrospecLive cohorL sLudy was conducLed on 268 LPIs delivered consecuLively in Daxing HospiLal AffiliaLed Lo CapiLal Medical UniversiLy,and Lhey were divided inLo Lhree groups:60 cases of 34 weeks group,75 cases of 35 weeks group and 133 cases of 36 weeks group,sLraLified by gesLa-Lional age(GA).MaLernal and neonaLal daLa,recovery,LemperaLure aL birLh(T丨)and 2 hours afLer birLh(T2)were ana-lyzed among all groups.Results SevenLy cases(26.1%)of LPIs were diagnosed pregnancy complicaLions during preg-nancy,and preeclampsia and inLrahepaLic cholesLasis were significanLly higher in Lhe 34 weeks group Lhan in Lhe 35 weeks and 36 weeks groups(all P<0.05).47 cases(17.5%)of LPIs were diagnosed venLilaLion resusciLaLion,36 cases(13.4%)needed oxygen resusciLaLion(mask or Lracheal inLubaLion),Lhe raLio of oxygen resusciLaLion in 34 weeks group was significanLly higher Lhan LhaL of Lhe 35 weeks group and 36 weeks group,and Lhe differences were sLaLisLically sig-nificanL(P<0.05).The differences in LPIs wiLh differenL gesLaLional age,and siLuaLion of prenaLal sLeroid Lherapy,sponLaneous preLerm birLh,cesarean secLion and preeclampsia of pregnanL moLher were sLaLisLically significanL(P<0.05).FeLal age was an independenL risk facLor for oxygen recovery of LPIs(P<0.05).From T丨Lo T2,Lhe raLio of nor-mal body LemperaLure of newborns in Lhe 34 weeks group was significanLly lower Lhan LhaL of Lhe 35 weeks group and 36 weeks group,and incidence of LPIs respiraLory diseases and NICU admission raLe of 34 weeks group were signifi-canLly higher Lhan Lhose of 35 weeks group and 36 weeks group,and Lhe differences were sLaLisLically significanL(P<0.05).Conclusion The lower Lhe GA of LPIs is,especially aL 34 gesLaLional weeks,Lhe more maLernal complicaLions,Lhe greaLer Lhe need for resusciLaLion in delivery room,Lhe risk of hypoLhermia,Lhe higher Lhe raLe of respiraLory di

关 键 词：晚期早产儿 过渡 新生儿窒息复苏 体温调节 妊娠期并发症 

分 类 号：R722[医药卫生—儿科]