窒息新生儿糖代谢紊乱对近期预后的影响:一项湖北省多中心研究  

Effect of glucose metabolism disorders on the short-term prognosis in neonates with asphyxia:a multicenter study in Hubei Province,China

作　　者：刘春花 王慧[2] 彭斯聪 王文翔 焦蓉 潘莎 朱天娇[4] 栾小英 朱晓芳[6] 吴素英 魏德国 付冰峰[9] 严瑞红 杨树杰[11] 罗亚辉[12] 李桂萍[13] 杨敏[14] 贾德昭[15] 高创 肖雄飞 熊莉[18] 孙捷[19] 肖家鹏 李波文 李燕妮 张连红[23] 李天国 程敏[24] 夏建新 夏世文 LIU Chun-Hua;WANG Hui;PENG Si-Cong;WANG Wen-Xiang;JIAO Rong;PAN Sha;ZHU Tian-Jiao;LUAN Xiao-Ying;ZHU Xiao-Fang;WU Su-Ying;WEI De-Guo;FU Bing-Feng;YAN Rui-Hong;YANG Shu-Jie;LUO Ya-Hui;LI Gui Ping;YANG Min;JIA De-Zhao;GAO Chuang;XIAO Xiong-Fei;XIONG Li;SUN Jie;XIAO Jia-Peng;LI Bo-Wen;LI Yan Ni;ZHANG Lian-Hong;LI Tian-Guo;CHENG Min;XIA Jian-Xin;XIA Shi-Wen(School of Medicine,Wuhan University of Science and Technology,Wuhan 430065,China)

机构地区：[1]武汉科技大学医学院,湖北武汉430065 [2]华中科技大学同济医学院附属湖北妇幼保健院新生儿科,湖北武汉430070 [3]湖北医药学院附属襄阳市第一人民医院儿科,湖北襄阳441000 [4]咸宁市中心医院/湖北科技学院附属第一医院新生儿科,湖北咸宁437100 [5]云梦县中医医院儿科,湖北云梦432500 [6]荆州市中心医院(长江大学附属第二临床学院)新生儿科,湖北荆州434020 [7]湖北民族大学附属民大医院新生儿科,湖北恩施445000 [8]谷城县妇幼保健计划生育服务中心儿科,湖北谷城441700 [9]荆州市第一人民医院(长江大学附属第一医院)新生儿科,湖北荆州434000 [10]公安县人民医院儿科,湖北公安434300 [11]武汉科技大学附属孝感医院新生儿科,湖北孝感432100 [12]汉川市人民医院新生儿科,湖北汉川431600 [13]麻城市人民医院儿科,湖北麻城438300 [14]湖北医药学院附属太和医院儿童医疗中心儿科二病区,湖北十堰442000 [15]随州市中心医院新生儿科,湖北随州441300 [16]英山县人民医院儿科,湖北英山438700 [17]天门市妇幼保健院新生儿科,湖北天门431700 [18]松滋市妇幼保健院新生儿科,湖北松滋434200 [19]黄冈市中心医院儿童保健科,湖北黄冈438000 [20]罗田县人民医院儿科,湖北罗田438600 [21]咸宁市咸安区妇幼保健院新生儿科,湖北咸宁437100 [22]襄阳市妇幼保健院江北儿科,湖北襄阳441000 [23]天门市第一人民医院新生儿科,湖北天门431700 [24]黄梅县妇幼保健院新生儿科,湖北黄梅435500 [25]麻城市妇幼保健院新生儿科,湖北麻城438300

出　　处：《中国当代儿科杂志》2021年第12期1208-1213,共6页Chinese Journal of Contemporary Pediatrics

基　　金：湖北省妇幼保健院院内科研项目(湖北省新生儿窒息多中心流行病学调查及质量改进研究)。

摘　　要：目的分析窒息新生儿糖代谢紊乱对近期预后的影响。方法回顾性纳入湖北省52家医院2018年1~12月收治的生后12 h内有血糖数据的窒息患儿,收集病历资料及生后1、2、6、12 h的血糖数据,允许时间误差为0.5 h。根据住院期间是否诊断脑损伤和/或死亡分为预后不良组(693例)及预后良好组(779例)。分析两组患儿生后12 h内糖代谢紊乱情况及其对近期预后的影响。结果预后不良组中来自二级医院(48.5%vs 42.6%)、重度窒息(19.8%vs 8.1%)、亚低温治疗(4.8%vs 1.5%)的比例及糖代谢紊乱发生率(18.8%vs 12.5%)均高于预后良好组(P<0.05);预后不良组生后1、2、6 h糖代谢紊乱发生率均高于预后良好组(P<0.05)。多因素logistic回归分析显示,反复高血糖为窒息患儿预后不良的独立危险因素(校正后OR=2.380,95%CI:1.275~4.442,P<0.05)。结论窒息患儿合并反复高血糖可能提示近期预后不良,应加强对该类患儿的早期神经系统监测与管理。Objective To study the effect of glucose metabolism disorders on the short-term prognosis in neonates with asphyxia.Methods A retrospective analysis was performed on the medical data of the neonates with asphyxia who were admitted to 52 hospitals in Hubei Province of China from January to December,2018 and had blood glucose data within 12 hours after birth.Their blood glucose data at 1,2,6,and 12 hours after birth(with an allowable time error of 0.5 hour)were recorded.According to the presence or absence of brain injury and/or death during hospitalization,the neonates were divided into a poor prognosis group with 693 neonates and a good prognosis group with 779 neonates.The two groups were compared in the incidence of glucose metabolism disorders within 12 hours after birth and short term prognosis.Results Compared with the good prognosis group,the poor prognosis group had a significantly higher proportion of neonates from secondary hospitals(48.5%vs 42.6%,P<0.05)or with severe asphyxia(19.8%vs 8.1%,P<0.05)or hypothermia therapy(4.8%vs 1.5%,P<0.05),as well as a significantly higher incidence rate of disorder of glucose metabolism(18.8%vs 12.5%,P<0.05).Compared with the good prognosis group,the poor prognosis group had a significantly higher incidence rate of disorder of glucose metabolism at 1,2,and 6 hours after birth(P<0.05).The multivariate logistic regression analysis showed that recurrent hyperglycemia(adjusted odds ratio=2.380,95%confidence interval:1.275-4.442,P<0.05)was an independent risk factor for poor prognosis in neonates with asphyxia.Conclusions Recurrent hyperglycemia in neonates with asphyxia may suggest poor short-term prognosis,and it is necessary to strengthen the early monitoring and management of the nervous system in such neonates.

关 键 词：窒息 高血糖 预后 新生儿 

分 类 号：R722.1[医药卫生—儿科]