143例新生儿肺出血不良预后原因分析  

Analysis of the causes of poor prognosis in 143 cases of neonatal pulmonary hemorrhage

作　　者：张二清 郑明琼 徐小静 ZHANG Erqing;ZHENG Mingqiong;XU Xiaojing(Department of Pediatrics,the First Hospital of Tsinghua University,Beijing 100016,China)

机构地区：[1]清华大学第一附属医院儿科,北京100016

出　　处：《中国研究型医院》2022年第4期64-67,共4页Chinese Research Hospitals

摘　　要：目的探讨新生儿肺出血不良预后的影响因素,为早期识别和提高抢救成功率提供理论依据。方法搜集2009年1月—2020年12月确诊为新生儿肺出血的143例病例资料进行回顾性分析,根据临床结局分为存活组84例和病死组59例。对与肺出血关系密切的影响因素进行单因素及多因素分析。单因素分析采用t检验与χ^(2)检验,多因素分析应用Logistic回归,计算影响因素OR值以及95%CI。结果143例中,新生儿肺出血的病死率为41.26%(59/143)。两组单因素分析中,胎龄、出生体质量、重度窒息、弥散性血管内凝血(DIC)、多脏器损害、休克、肺出血前血pH值、白细胞计数,差异具有统计学意义(P值均<0.05);多因素Logistic回归分析提示胎龄(OR=0.831,95%CI:0.754~0.915)、休克(OR=8.918,95%CI:3.534~22.506)是新生儿肺出血不良预后的独立危险因素。结论胎龄、休克是新生儿肺出血不良预后的独立危险因素,对发生休克的肺出血患儿,尤其是胎龄小的患儿应采取更积极的干预措施,以降低病死率。Objective To explore the influencing factors for poor prognosis of neonatal pulmonary haemorrhage and to provide a theoretical basis for early identification and improving the success rate of resuscitation.Methods The data of 143 cases diagnosed with neonatal pulmonary haemorrhage from January 2009 to December 2020 were collected for retrospective analysis and were divided into 84 cases in the survival group and 59 cases in the morbidity and mortality group according to clinical outcomes.Single-factor and multi-factor analyses were performed for influencing factors strongly associated with pulmonary haemorrhage.Single-factor analysis was performed by t-test withχ^(2)-test,multi-factor applied Logistic regression analysis to calculate OR value of influencing factors and 95%CI.Results The study's mortality rate of neonatal pulmonary haemorrhage was 41.26%in 143 cases(59/143).In the single-factor analysis of both groups,the differences were statistically significant for gestational age,birth mass,severe asphyxia,disseminated intravascular coagulation(DIC),multiple organ damage,shock,pH of blood gas analysis before pulmonary haemorrhage,and white blood cell count(all P<0.05).Multi-factor Logistic regression analysis showed that gestational age(OR=0.831,95%CI:0.754-0.915)and shock(OR=8.918,95%CI:3.534-22.506)were the independent risk factors for poor prognosis of neonatal pulmonary haemorrhage.Conclusion Gestational age and shock are the independent risk factors for poor prognosis of neonatal pulmonary haemorrhage.More aggressive interventions should be taken for children with pulmonary hemorrhage who develop shock,especially those of small gestational age,to reduce the morbidity and mortality.

关 键 词：新生儿肺出血 死亡 危险因素 LOGISTIC模型 

分 类 号：R722.1[医药卫生—儿科]