2017年至2019年复苏质量改进情况及其对极低出生体重儿复苏效果的影响  

Resuscitation quality improvement and its outcomes in very low birth weight infants from 2017 to 2019

作　　者：欧姜凤 钟晓云[1] 吴艳[1] 章晓婷[1] 龚华[1] 陈文[1] Ou Jiangfeng;Zhong Xiaoyun;Wu Yan;Zhang Xiaoting;Gong Hua;Chen Wen(Department of Neonatology,Chongqing Health Center for Women and Children,Chongqing 401147,China)

机构地区：[1]重庆市妇幼保健院新生儿科,401147

出　　处：《中华围产医学杂志》2020年第9期600-607,共8页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨2017年至2019年极低出生体重儿(very low birth weight infant,VLBWI)复苏质量改进情况及其对复苏效果的影响。方法回顾性纳入2017年1月1日至2019年12月31日在重庆市妇幼保健院出生并转入新生儿重症监护病房的VLBWI 318例。按照具体复苏策略实施情况分为3组:2017年为复苏质量改进前(n=83),2018年为改进中(n=102),2019年为改进后(n=133)。分析比较各年复苏策略,包括体温管理、延迟脐带结扎(delayed cord clamping,DCC)、呼吸支持[产房持续气道正压通气(continuous positive airway pressure,CPAP)、正压通气或气管插管使用]和氧疗[复苏初始吸入氧浓度(fraction of inspired oxygen,FiO2)、复苏最高FiO2以及纯氧复苏]实施情况、复苏效果及转归。采用趋势χ2检验、Kruskal-Wallis H检验、Wilcoxon轶和检验、方差分析及LSD检验进行统计分析。结果(1)母亲产前足疗程糖皮质激素使用比例在2017年至2019年逐年上升[44.6%(37/83)、47.1%(48/102)与72.2%(96/133),χ2趋势=18.218,P<0.001]。(2)入院时低体温比例逐年下降[100.0%(83/83)、90.2%(92/102)与33.8%(45/133),χ2趋势=136.042,P<0.001],且并未增加体温过高比例[0.0%(0/83)、1.0%(1/102)与0.0%(0/133),χ2趋势=2.124,P=0.346]。(3)DCC比例逐年增加[0.0%(0/83)、29.4%(30/102)与90.2%(120/133),χ2趋势=178.659,P<0.001],生后12~24 h毛细血管血血红蛋白含量逐年上升[(190.1±34.8)、(202.0±29.7)与(213.6±32.3)g/L,LSD检验,P值均<0.05]。疑似红细胞增多症(毛细血管血红细胞压积>68%)发生率逐年增加[7.2%(6/83)、7.8%(8/102)与17.3(23/133),χ2趋势=5.825,P=0.016];除外没有检测静脉血红细胞压积的病例,2017、2018和2019年VLBWI红细胞增多症确诊(静脉血红细胞压积>65%)率并未增加[1.3%(1/80)、2.0%(2/100)与4.8%(6/126),χ2趋势=2.333,P=0.127]。(4)产房CPAP使用比例逐年增加[0.0%(0/83)、28.4%(29/102)与87.2%(116/133),χ2趋势=167.721,P<0.001];产房内正压通气比例[44.6%(37/83)、31.9%(32/102)�Objective To understand quality improvement(QI)in resuscitation and its impacts on the outcomes in very low birth weight infants(VLBWI).Methods This was a retrospective study involving 318 cases of VLBWI born in Chongqing Health Center for Women and Children and transferred to the Neonatal Intensive Care Unit(NICU)in the same hospital from January 1,2017 to December 31,2019.All recruited VLBWIs were divided into three groups based on chronological order:pre-QI group(born in 2017,n=83),under-QI group(born in 2018,n=102)and post-QI group(born in 2019,n=133).The implementation and effects of different resuscitation strategies,including body temperature management,delayed cord clamping(DCC),respiratory support[continuous positive airway pressure(CPAP)in the delivery room,positive pressure ventilation or tracheal intubation]and oxygen therapy[initial fraction of inspired oxygen(FiO2),maximum FiO2 and pure oxygen resuscitation],and the neonatal outcomes in each year were analyzed and compared by trend Chi-square test,Kruskal-Wallis H test,Wilcoxon rank-sum test,analysis of variance and LSD test.Results(1)The proportion of antenatal steroid exposure increased gradually during the three years[44.6%(37/83),47.1%(48/102),72.2%(96/133);χ2trend=18.218,P<0.001].(2)From 2017 to 2019,the incidence of hypothermia on admission decreased[100.0%(83/83),90.2%(92/102),33.8%(45/133);χ2trend=136.042,P<0.001],without increasing the proportion of hyperthermia[0.0%(0/83),1.0%(1/102),0.0%(0/133);χ2trend=2.124,P=0.346].(3)The proportion of VLBWIs receiving DCC increased annually[0.0%(0/83),29.4%(30/102),90.2%(120/133);χ2trend=178.659,P<0.001],and the concentration of capillary hemoglobin within 12-24 h after birth also increased[(190.1±34.8),(202.0±29.7),(213.6±32.3)g/L;LSD test,P<0.05].The incidence of suspected polycythemia(capillary hematocrit>68%)increased annually[7.2%(6/83),7.8%(8/102),17.3(23/133);χ2trend=5.825,P=0.016];While the incidence of confirmed polycythemia(venous hematocrit>65%)was not increased[1.3%(1/80),2.0%(2/100

关 键 词：婴儿 极低出生体重 复苏术 质量改进 治疗结果 

分 类 号：R722.1[医药卫生—儿科]