双胎妊娠新生儿窒息的高危因素  

Risk factors of neonatal asphyxia in twin pregnancy

作　　者：陆澄秋[1] 肖玲玲[1] 钱蓓倩[1] 张成强[1] 汪吉梅[1] Lu Chengqiu;Xiao Lingling;Qian Beiqian;Zhang Chengqiang;Wang Jimei(Department of Neonatology,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200011,China)

机构地区：[1]复旦大学附属妇产科医院新生儿科,上海200011

出　　处：《中华围产医学杂志》2021年第3期194-199,共6页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨双胎妊娠新生儿窒息发生情况及其影响因素。方法回顾性纳入2010年1月至2018年12月在复旦大学附属妇产科医院分娩且双胎均活产的双胎妊娠孕妇2035例及其4070例活产新生儿,其中211例窒息新生儿作为窒息组,余未发生窒息的3859例新生儿作为非窒息组。采用两独立样本t检验、χ^(2)检验和χ^(2)趋势检验比较组间产妇及新生儿一般资料及围产期并发症情况,采用多因素logistic回归分析双胎新生儿窒息的危险因素。结果2035例孕妇年龄为(31.8±4.4)岁(17~52岁)。分娩孕周为(35.2±2.2)周(25~40周),早产1330例(65.4%),其中≥34周的早产997例(49.0%)。单绒毛膜双羊膜囊双胎妊娠占22.6%(460/2035)。4070例新生儿总体窒息发生率为5.2%(211/4070),其中双胎之大为5.0%(102/2035),双胎之小为5.4%(109/2035)。随着胎龄增加,双胎之大、双胎之小和总体的窒息发生率呈下降趋势(χ^(2)趋势值分别为549.693、1089.709和1601.965,P值均<0.001);随着出生体重增大,双胎之大、双胎之小和总体的窒息发生率也呈下降趋势(χ^(2)趋势值分别为437.906、848.007和1273.386,P值均<0.001)。单因素分析显示,窒息组较非窒息组胎龄及出生体重低[(34.1±2.8)与(35.3±2.1)周,t=6.279;(2113.3±565.7)与(2339.6±478.7)g,t=5.700],而男婴[58.3%(123/211)与48.5%(1878/3859),χ^(2)=7.704]、阴道分娩[10.4%(22/211)与4.5%(173/3859),χ^(2)=15.493]、单绒毛膜双羊膜囊[27.5%(58/211)与22.3%(862/3859),χ^(2)=7.714]、单绒毛膜双羊膜囊双胎特殊并发症[8.1%(17/211)与2.5%(95/3859),χ^(2)=23.403]和胎儿窘迫[13.7%(29/211)与3.8%(148/3859),χ^(2)=47.222]的比例高(P值均<0.05)。校正胎龄、出生体重、性别后的多因素分析发现,阴道分娩(OR=1.748,95%CI:1.069~2.861)、单绒毛膜双羊膜囊双胎特殊并发症(OR=3.200,95%CI:2.056~4.982)和胎儿窘迫(OR=2.017,95%CI:1.073~3.791)是双胎新生儿窒息的危险因素(P值均<0.05)。结论胎龄小、出生体重低的�Objective To investigate the incidence and risk factors of neonatal asphyxia in twin pregnancy.Methods This study retrospectively recruited 2035 women with twin pregnancy and their 4070 twin neonates in the Obstetrics and Gynecology Hospital of Fudan University from January 2010 to December 2018.There were 211 cases suffered from neonatal asphyxia(asphyxia group)and 3859 did not(non-asphyxia group).The demographic information of the women and their newborns and the incidence of perinatal complications were compared between the two groups by two independent samples t-test and Chi-square test.Multivariate logistic regression was used to analyze the risk factors of neonatal asphyxia in twin pregnancy.Results The age of 2035 women was(31.8±4.4)years old(17-52 years old).The gestational age of the twins at delivery was(35.2±2.2)weeks(25-40 weeks).There were 1330(65.4%)premature births,including 997(49.0%)born at≥34 weeks.Monochorionic diamniotic twin pregnancies accounted for 22.6%(460/2035).The total incidence of neonatal asphyxia was 5.2%(211/4070),5.0%(102/2035)in the first-and 5.4%(109/2035)in the second-born twin infants,and the three figures were all decreased with the increase of gestational age(χ^(2)_(trend)=1601.965,549.693 and 1089.709,all P<0.001)as well as birth weight(χ^(2)_(trend)=1273.386,437.906 and 848.007,all P<0.001).Univariate analysis showed that the asphyxia group had smaller gestational age and lower birth weight[(34.1±2.8)vs(35.3±2.1)weeks,t=6.279;(2113.3±565.7)vs(2339.6±478.7)g,t=5.700],but a higher ratio of male infants[58.3%(123/211)vs 48.5%(1878/3859),χ^(2)=7.704],vaginal delivery[10.4%(22/211)vs 4.5%(173/3859),χ^(2)=15.493],monochorionic diamniotic twins[27.5%(58/211)vs 22.3%(862/3859),χ^(2)=7.714],special complications related to monochorionic diamniotic twin pregnancies[8.1%(17/211)vs 2.5%(95/3859),χ^(2)=23.403]and fetal distress[13.7%(29/211)vs 3.8%(148/3859),χ^(2)=47.222]than the non-asphyxia group(all P<0.05).After adjusting for the gestational age,birth weight and gend

关 键 词：妊娠 双胎 新生儿窒息 危险因素 

分 类 号：R722.12[医药卫生—儿科]