超早产儿生存现状及预后分析  

The survival,complications and prognosis of the extremely preterm infants

作　　者：夏磊[1] 关豪 王文秀 张樱彦 华敏敏[1] 徐发林[1] Xia Lei;Guan Hao;Wang Wenxiu;Zhang Yingyan;Hua Minmin;Xu Falin(Department of Neonatology,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院新生儿科,郑州450052

出　　处：《中华新生儿科杂志（中英文）》2023年第6期344-348,共5页Chinese Journal of Neonatology

基　　金：河南省医学科技攻关联合共建项目(LHGJ20220540)。

摘　　要：目的分析胎龄<28周超早产儿并发症及预后。方法本研究为单中心回顾性研究,选择郑州大学第三附属医院新生儿重症监护室2016年1月至2020年12月收治的胎龄<28周超早产儿为研究对象,收集患儿及其母亲孕期临床资料,根据预后情况分为存活组、死亡组、放弃组,根据胎龄分为<26周组、26~26+6周组、≥27周组,根据出生体重分为≤750 g组、750~999 g组、≥1000 g组,采用SPSS 26.0进行数据分析。结果共纳入265例超早产儿,存活组122例(46.0%),死亡组47例(17.7%),放弃组96例(36.2%)。存活组胎龄、出生体重高于死亡组和放弃组,差异有统计学意义(P<0.05);3组中死亡组气管插管(92.2%)、肺出血(42.2%)比例最高,存活组产前应用糖皮质激素(80.3%)、肺表面活性物质应用(99.2%)比例最高,差异均有统计学意义(P<0.05)。存活组常见并发症前3位为支气管肺发育不良(68.0%)、感染性肺炎(65.6%)、新生儿败血症(34.4%)。根据胎龄、出生体重分组,发现存活率随胎龄、出生体重增加逐渐增加。结论超早产儿存活率与胎龄及出生体重密切相关,发生肺出血、需气管插管的患儿预后较差,产前使用糖皮质激素、应用肺表面活性物质有助于改善患儿结局;支气管肺发育不良、感染性肺炎是存活超早产儿常见并发症。Objective To study the complications and prognosis of extremely premature infants(EPIs)with gestational age(GA)<28 w.Methods From January 2016 to December 2020,EPIs with GA<28 w admitted to NICU of our hospital were retrospectively studied.Clinical data of the infants and their mothers during pregnancy were reviewed.According to the prognosis,the infants were assigned into the survival group,the death group and the withdrawal group.According to GA,the infants were assigned into<26 w goup,26~26+6 w group,≥27 w group.According to birth weight(BW),the infants were assigned in to≤750 g group,750~999 g group and≥1000 g group.SPSS 26.0 was used for data analysis.Results A total of 265 EPIs were included,122(46.0%)in the survival group,47(17.7%)in the death group and 96(36.2%)in the withdrawal group.GA and BW of the survival group were significantly higher than the death group and the withdrawal group(P<0.05).The incidences of tracheal intubation(92.2%)and pulmonary hemorrhage(42.2%)in the death group were the highest among the three groups.The survival group had the highest application of prenatal glucocorticoids(80.3%)and pulmonary surfactants(99.2%)(P<0.05).In the survival group,the top 3 common complications were bronchopulmonary dysplasia(BPD)(68.0%),pulmonary infections(65.6%)and neonatal sepsis(34.4%).The survival rate increased with GA and BW.Conclusions The survival rate of EPIs is closely correlated with GA and BW.EPIs with pulmonary hemorrhage and tracheal intubation have poor prognosis.Prenatal glucocorticoids and pulmonary surfactant may improve clinical outcome.BPD and pulmonary infections are common complications of surviving EPIs.

关 键 词：超早产儿 并发症 糖皮质激素 

分 类 号：R722.6[医药卫生—儿科]