“早产儿过渡期干预措施”改进对超早产儿结局的影响  

Effects of intervention program from prenatal period to delivery room on outcomes of extremely preterm infants

作　　者：吴艳[1] 钟晓云[1] 周利刚[1] 龚华[1] Yan Wu;Xiaoyun Zhong;Ligang Zhou;Hua Gong(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,重庆401147

出　　处：《中华围产医学杂志》2022年第4期263-270,共8页Chinese Journal of Perinatal Medicine

基　　金：重庆市自然科学基金面上项目(cstc2020jcyj-msxmX0483)。

摘　　要：目的总结分析"早产儿过渡期干预措施"实施和质量持续改进对超早产儿(extremely preterm infant, EPI)住院期间结局及死亡的影响因素。方法回顾性纳入2014年7月1日至2021年6月30日在重庆市妇幼保健院出生并入住新生儿重症监护病房(neonatal intensive care unit, NICU)的185例EPI, 根据2018年1月在本院实施"早产儿过渡期干预措施"改进前后分为改进前组(2014年7月至2017年12月, n=45)和改进后组(2018年1月至2021年6月, n=140), 使用t检验、Mann-WhitneyU检验和χ^(2)检验比较2组存活率和并发症发生情况;通过单因素筛选和logistic回归分析EPI死亡的影响因素。结果 (1)185例EPI的中位胎龄26周+6, 范围23周+3~27周+6, 中位出生体重950 g, 范围390~1 290 g。(2)改进后, 新生儿科医生参与产前会诊比例、母亲产前足疗程糖皮质激素和硫酸镁使用比例、剖宫产娩出比例及转入NICU体温均提高[分别为77.1%(108/140)与8.9%(4/45)、67.9%(95/140)与35.6%(16/45)、67.1%(94/140)与48.9%(22/45)、44.3%(62/140)与17.8%(8/45)及36.6 ℃(36.3~36.9 ℃)与35.2 ℃(35.0~35.3 ℃), χ^(2)或Z值分别为66.41、14.81、4.85、10.17及-9.34, P值均<0.05], 且延迟脐带结扎(delayed cord clamping, DCC)和出生后经鼻持续气道正压通气(nasal continuous positive airway pressure, nCPAP)呼吸支持比例分别由改进前的无病例至改进后的67.9%(95/140)和89.3%(125/140);而生后1 min Apgar评分≤3分、产房内气管插管及72 h内有创呼吸机使用等比例均较降低[分别为7.1%(10/140)与17.8%(8/45)、37.1%(52/140)与73.3%(33/45)、38.6%(54/140)与57.8%(26/45), χ^(2)值分别为4.39、17.96及5.12, P值均<0.05]。(3)改进后, EPI总体救治存活率及胎龄27~27周+6的存活率均明显提升[分别为72.9%(102/140)与53.3%(24/45), OR=2.349, P=0.015;84.1%(53/63)与56.6%(13/23), OR=4.077, P=0.007];虽然早产儿脑室周围-脑室内出血、晚发型败血症和早产儿视网膜病变的发生率呈下降趋势, 但差异均Objective:To analyze the outcomes of extremely preterm infants(EPIs)after the implementation and quality improvement of an intervention program from the prenatal period to delivery room and the factors influencing the mortality of EPIs.Methods:This was a retrospective study involving 185 EPIs admitted to neonatal intensive care unit(NICU)of Chongqing Health Center for Women and Children from July 1,2014,to June 30,2021.The intervention program from the prenatal period to delivery room was implemented in our hospital in January 2018,according to which,EPIs who were admitted before this time were grouped as the historical group(n=45)and those who were admitted after as the program group(n=140).The survival rate and morbidity of the two groups were analyzed and compared using t test,Mann Whitney U test,and Chi-square test.The factors influencing the mortality of EPIs were analyzed by univariate screening and logistic regression.Results:(1)The median gestational age of these EPIs was 26+6 weeks,ranging from 23+3 to 27+6 weeks,and the median birth weight was 950 g,ranging from 390 g to 1290 g.(2)After the intervention,the proportion of patients in whom the neonatologists were involved in prenatal consultation,women who received a full course of antenatal corticosteroid and magnesium sulfate,and cesarean delivery as well as the neonatal temperature on admission to NICU all increased significantly[77.1%(108/140)vs 8.9%(4/45);67.9%(95/140)vs 35.6%(16/45);67.1%(94/140)vs 48.9%(22/45);44.3%(62/140)vs 17.8%(8/45);36.6℃(36.3-36.9℃)vs 35.2℃(35.0-35.3℃),respectively,χ^(2) or Z values were 66.41,14.81,4.85,10.17 and-9.34,respectively,all P<0.05].Both delayed cord clamping(DCC)and nasal continuous positive airway pressure(nCPAP)were included in the intervention program,with implementation rates from zero before to 67.9%(95/140)and 89.3%(125/140),respectively.Compared to the historical group,the proportion of infants with 1-minute Apgar score≤3,endotracheal intubation in the delivery room or mechanical ventilation with

关 键 词：婴儿 极度早产 存活率 死亡率 早期医疗干预 

分 类 号：R722.6[医药卫生—儿科]