新生儿休克99例病因及死亡危险因素分析  

Analysis of etiologies in 99 cases of neonatal shock and risk factors of mortality

作　　者：蒲伟丛[1] 焦建成[1] 孟灵芝[1] 贾超 房军臣 张玉东 夏耀方[1] 马莉[1] Pu Weicong;Jiao Jiancheng;Meng Lingzhi;Jia Chao;Fang Junchen;Zhang Yudong;Xia Yaofang;Ma Li(Department of Neonatology,Hebei Provincial Children's Hospital,Shijiazhuang 050031,China)

机构地区：[1]河北省儿童医院新生儿科,石家庄050031

出　　处：《中华新生儿科杂志（中英文）》2021年第3期30-33,共4页Chinese Journal of Neonatology

基　　金：河北省医学科学研究课题(20211005)。

摘　　要：目的分析新生儿休克的病因及临床特征,探讨其死亡相关危险因素。方法回顾性收集2018年1月至2020年9月河北省儿童医院新生儿科收治的休克患儿的临床资料,分析其病因及临床特征,根据临床结局分为治愈组和死亡组,通过单因素χ2检验和多因素Logistic回归分析探讨休克患儿死亡的相关危险因素。结果共纳入新生儿休克患儿99例,男性55例(55.6%),胎龄(37.7±2.9)周,其中早产儿26例,足月儿73例,中位入院日龄12 d。按病因分类,以感染性休克为主(78例,78.8%),其次为心源性和低血容量性(各6例,6.1%)、窒息性(5例,5.1%)等;感染性休克患儿血培养大肠埃希菌、无乳链球菌是最常见致病菌。总病死率21.2%,早产儿病死率高于足月儿(42.3%比13.7%,P<0.05)。死亡组患儿出生体重<2500 g、胎龄<37周、入院日龄<3 d、入院pH<7.15、入院时乳酸>4 mmol/L、低血压、凝血功能障碍、多器官功能障碍综合征比例高于治愈组;多因素Logistic回归分析显示入院pH<7.15、低血压是休克患儿死亡的独立危险因素。结论新生儿休克病因以感染性为主,入院pH<7.15、低血压是新生儿休克死亡的独立危险因素。Objective To study the etiologies and clinical features of neonatal shock and evaluate the risk factors of mortality.Method From January 2018 to September 2020,the clinical data of neonatal shock patients admitted to neonatal intensive care unit of our hospital were retrospectively collected.Their etiologies and clinical features were analyzed.The infants were assigned into the cured group and the death group.The risk factors for death were analyzed using univariate and multivariate Logistic regression methods.Result A total of 99 neonatal shock cases were collected.The neonates had a gestational age(GA)of(37.7±2.9)weeks,a birth weight(BW)of(2969±756)g,and male 55,female 44.The median age on admission was 12 days.26 cases were premature infants.The most common type of shock was septic shock(78/99,78.8%).The other causes included cardiogenic(6/99,6.1%),hypovolemic(6/99,6.1%),asphyxial(5/99,5.1%)and congenital genetic metabolic diseases(4/99,4.0%).The mortality rate was 21.2%(21/99).Escherichia coli and Group B streptococcus were the most common pathogenic bacteria.The mortality was significantly higher in premature infants than the full-term infants(42.3%vs.13.7%,P<0.05).The death group had significantly higher incidences of infants with BW<2500 g,GA<37 weeks,admission age<3 d,pH<7.15 on admission,blood lactic acid(>4 mmol/L)on admission,hypotension,coagulation dysfunction,multiple organ dysfunction syndrome than the cured group.Logistic regression analysis indicated that pH<7.15 on admission and hypotension were the independent risk factors of death.Conclusion Septic shock is the leading cause of neonatal shock in our patients.pH<7.15 on admission and hypotension are the independent risk factors of death from neonatal shock.

关 键 词：婴儿 新生 休克 脓毒症 死亡 危险因素 

分 类 号：R722.1[医药卫生—儿科]