单中心胎龄22周^(+0)~25周^(+6)超未成熟儿死亡率及其与国外数据的比较  

Mortality of extremely preterm infants born at 22^(+0)-25^(+6) gestational weeks in a single center and comparison with data from other countries

作　　者：丁方睿 马俊苓[1] 田秀英[1] 郑军[1] Ding Fangrui;Ma Junling;Tian Xiuying;Zheng Jun(Department of Neonatology,Tianjin Central Hospital of Obstetrics and Gynecology,Tianjin Key Laboratory of Human Development and Reproductive Regulation,Tianjin 300100,China)

机构地区：[1]天津市中心妇产科医院新生儿科,天津市人类发育与生殖调控重点实验室,300100

出　　处：《中华围产医学杂志》2021年第4期297-302,共6页Chinese Journal of Perinatal Medicine

基　　金：国家自然科学基金(81800634);天津市科技计划项目(18ZXRHSY00170)。

摘　　要：目的收集本中心胎龄22周^(+0~)25周^(+6)超未成熟儿死亡率,并与同期国外数据进行比较。方法回顾性收集2011年1月至2017年12月在天津市中心妇产科医院出生的胎龄22周^(+0~)25周^(+6)超未成熟儿病例信息,根据胎龄、出生体重、入院时间分别分组并分析其死亡率。同时收集国内外同期同胎龄超未成熟儿死亡率数据,根据选择数据的纳排标准,最终确定了5组数据,分别来自于我国15家多中心研究、美国、加拿大、澳大利亚和新西兰、韩国全国新生儿协作网数据,将该5组数据中死亡人群定义与本研究相同的数据通过χ^(2)检验对死亡率进行比较,同时分析患儿的死因。结果(1)本研究纳入胎龄22周^(+0~)25周^(+6)超未成熟儿64例,其总体死亡率为42.2%(27/64),死亡原因分为新生儿呼吸窘迫综合征[59.3%(16/27)]、坏死性小肠结肠炎[11.1%(3/27)]、严重脑室内出血[11.1%(3/27)]、败血症[7.4%(2/27)]、其他[11.1%(3/27)]。胎龄22周^(+0~)22周^(+6)、23周^(+0~)23周^(+6)、24周^(+0~)24周^(+6)、25周^(+0~)25周^(+6)死亡率分别为1/1、8/10、50.0%(10/20)、24.2%(8/33)。体重≤600 g、>600~≤800 g、>800~≤1000 g、>1000 g死亡率分别5/6、50.0%(16/32)、25.0%(6/24)、0/2。2016年以前(2011年至2015年)、2016年、2017年死亡率分别为57.1%(12/21)、45.0%(9/20)、26.1%(6/23)。(2)国外数据中,加拿大、澳大利亚和新西兰、韩国全国新生儿协作网数据死亡人群定义与本研究的相同,死亡率结果比较显示,本中心超未成熟儿总体死亡率42.2%高于加拿大26.6%(165/621)(χ^(2)=7.015,P=0.008)、澳大利亚和新西兰28.2%(140/497)(χ^(2)=5.330,P=0.021),与韩国死亡率42.1%(218/518)相比差异无统计学意义(χ^(2)<0.001,P=0.988)。结论本中心出生胎龄22周^(+0~)25周^(+6)超未成熟儿死亡率仍然较高,与加拿大、澳大利亚等发达国家相比仍有差距,未来诊疗中应不断提高救治能力并通过质量改进降低死亡率。Objective To analyze the mortality of extremely preterm infants(EPIs)born at 22+^(0-)25^(+6)weeks of gestation in Tianjin Central Hospital of Obstetrics and Gynecology and then compare it with data from other countries to provide evidence for better healthcare for this population.Methods Clinical data of EPIs born at 22+^(0-)25^(+6)gestational weeks in our center from January 2011 to December 2017 were retrospectively collected.The enrolled patients were grouped based on their gestational age,birth weight,and admission time in order to analyze the mortality in different groups.According to the inclusion and exclusion criteria,five sets of data regarding the mortality of EPIs born at 22+^(0-)25^(+6)gestational weeks during the same period were retrieved from a multicenter survey involving 15 centers in China,the National Institute of Child Health and Human Development Neonatal Research Network(NICHD-NRN)in the United States,Canadian Neonatal NetworkTM,Australian and New Zealand Neonatal Network(ANZNN)and Korean Neonatal Network(KNN).The mortality rate among data from different sources was compared using Chi-square test on the condition that the definition of death was the same.Besides,the causes of neonatal death were analyzed.Results A total of 64 EPIs were enrolled in our center.The total mortality rate was 42.2%(27/64),and were 1/1,8/10,50.0%(10/20)and 24.2%(8/33)in EPIs of gestational age of 22+^(0-)22^(+6),23+^(0-)23^(+6),24+^(0-)24^(+6)and 25+^(0-)25^(+6)weeks,5/6,50.0%(16/32),25.0%(6/24)and 0/2 in those with birth weight of≤600 g,>600-≤800 g,>800-≤1000 g and>1000 g,respectively.In the 27 death cases in our center,the causes of death were as follows:neonatal respiratory distress syndrome(16 cases,59.3%),sepsis(two cases,7.4%),necrotizing enterocolitis(three cases,11.1%),severe intraventricular hemorrhage(three cases,11.1%)and others(three cases,11.1%).The mortality rate was 57.1%(12/21)before 2016(2011-2015),45.0%(9/20)in 2016 and 26.1%(6/23)in 2017.The total mortality of EPIs in our center was higher

关 键 词：婴儿 极度早产 婴儿死亡率 妊娠中期 回顾性研究 

分 类 号：R714.5[医药卫生—妇产科学]