影响重度新生儿缺氧缺血性脑病预后的LOGISTIC因素分析  

Analysis of Logistic Factors Influencing the Prognosis of Severe Neonatal Hypoxic-ischemic Encephalopathy

作　　者：翁海美[1] 林明静[1] 周丽霞 WENG Haimei;LIN Mingjing;ZHOU Lixia(Hainan People's Hospital,Hainan Haikou 570311,China)

机构地区：[1]海南省人民医院新生儿科,海南海口570311

出　　处：《河北医学》2020年第5期840-845,共6页Hebei Medicine

基　　金：海南省卫生和计划生育委员会课题,(编号:1801032031A2003)。

摘　　要：目的:探究影响重度新生儿缺氧缺血性脑病(HIE)预后的相关因素。方法:选取2016年1月至2019年4月本院诊治的重度HIE患儿134例为研究对象,均随访6个月,无失访病例。根据预后情况将患儿分为预后良好组、预后不良组,收集患儿临床资料,采用单因素及多因素Logistic回归法分析重度HIE患儿预后的影响因素。结果:随访结果统计显示,预后良好103例(76.87%),预后不良31例(23.13%);预后不良组中包括4例死亡,占比2.99%。单因素分析显示,重度HIE预后良好组与预后不良组患儿的5 min Apgar评分、脏器损伤、开始治疗日龄、血清tau蛋白水平比较差异有统计学意义(P<0.05);而性别、胎龄、出生体重、分娩方式、1 min Apgar评分比较差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,5 min Apgar评分≤3分(OR=58.658,95%CI=6.984~492.682)、脏器损伤≥2个(OR=31.145,95%CI=3.522~275.415)、开始治疗日龄≥48h(OR=33.747,95%CI=5.992~190.066)、血清tau蛋白≥8ng/L(OR=5.846,95%CI=1.372~24.918)是影响重度HIE患儿预后的危险因素(均P<0.05)。结论:5 min Apgar评分≤3分、脏器损伤≥2个、开始治疗日龄≥48h、血清tau蛋白≥8ng/L的重度HIE患儿发生预后不良的危险性更高,临床应加强针对性监护与及时干预。Objective:To explore the related factors that affected the prognosis of severe hypoxic-ischemic encephalopathy(HIE).Methods:A total of 134 children with severe HIE who were treated in our hospital from January 2016 to April 2019 were enrolled.All patients were followed up for 6 months without any loss of follow-up.According to the prognosis,the children were divided into a good prognosis group and a poor prognosis group.The clinical data of the children were collected.The factors affecting the prognosis of children with severe HIE were analyzed by single factor and multivariate logistic regression.Results:The follow-up results showed that the prognosis was good in 103 cases(76.87%),and the prognosis was poor in 31 cases(23.13%).The prognosis group included 4 deaths,accounting for 2.99%.Univariate analysis showed that the 5 min Apgar score,organ injury,starting treatment age,and serum tau protein levels were significantly different between the patients with severe HIE prognosis and those with poor prognosis(P<0.05).There was no significant difference in gestational age,birth weight,mode of delivery,and 1 min Apgar score(P>0.05).Multivariate logistic regression analysis showed that 5 min Apgar score≤3 points(OR=58.658,95%CI=6.984~492.682),organ damage≥2(OR=31.145,95%CI=3.522~275.415),starting treatment Age≥48h(OR=33.747,95%CI=5.992~190.066),serum tau≥8ng/L(OR=5.846,95%CI=1.372~24.918)are risk factors for the prognosis of children with severe HIE(all P<0.05).Conclusion:Patients with 5 min Apgar score≤3,organ injury≥2,age≥48h,and serum tau protein≥8ng/l have a higher risk of poor prognosis.Therefore,clinical monitoring and timely intervention should be strengthened.

关 键 词：新生儿 缺氧缺血性脑病 重度 预后 影响因素 

分 类 号：R722.1[医药卫生—儿科]