有创机械通气治疗后重度窒息新生儿预后的影响因素  

Influencing factors for prognosis of neonates with severe asphyxia after invasive mechanical ventilation therapy

作　　者：王慧慧[1] 沈怀云[1] 徐倩倩 刘彬彬 裴雪静 WANG Huihui;SHEN Huaiyun;XU Qianqian;LIU Binbin;PEI Xuejing(Department of Pediatrics,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,Anhui,China)

机构地区：[1]蚌埠医学院第一附属医院儿科,安徽省蚌埠市233004

出　　处：《广西医学》2023年第10期1157-1162,共6页Guangxi Medical Journal

摘　　要：目的探讨有创机械通气治疗后重度窒息新生儿预后的影响因素。方法回顾性分析110例行有创机械通气治疗的重度窒息新生儿的临床资料。根据预后情况,将研究对象分为成功组(n=75)和失败组(n=35)。比较两组新生儿的一般情况、合并症及并发症发生情况、入住新生儿ICU时的动脉血气分析结果。采用多因素Logistic回归模型分析重度窒息新生儿预后不良的危险因素。采用受试者工作特征(ROC)曲线分析动脉血气分析指标预测重度窒息新生儿预后的价值。结果(1)失败组新生儿羊水Ⅲ度污染比例、复苏时气管插管比例及入院时处于昏迷状态比例,以及心肌损害、肺出血、急性肾损伤、多器官功能障碍综合征(MODS)、高血糖及血小板减少的发生率均高于成功组,出生后5 min Apgar评分、pH值、PaO_(2)、碳酸氢根离子水平、碱剩余值均低于成功组(均P<0.05)。(2)多因素Logistic回归分析结果显示,入院时处于昏迷状态、出现肺出血、出现急性肾损伤、出现MODS、pH值低、PaO_(2)低、碱剩余值低均是重度窒息新生儿预后不良的危险因素(均P<0.05),pH值、PaO_(2)及碱剩余值对重度窒息新生儿的预后均具有一定的预测价值。结论对于行有创机械通气治疗的重度窒息新生儿,入院时处于昏迷状态、出现肺出血、出现急性肾损伤、出现MODS、较低pH值、较低PaO_(2)及较低碱剩余值是新生儿预后不良的危险因素,其中pH值、PaO_(2)及碱剩余值对新生儿预后有一定的预测价值。Objective To explore the influencing factors for prognosis of neonates with severe asphyxia after invasive mechanical ventilation therapy.Methods The clinical data of 110 severe asphyxia neonates undergoing invasive mechanical ventilation therapy were retrospectively analyzed,and the research subjects were assigned to success group(n=75)or failure group(n=35)according to the prognostic status.The general status,and occurrence of comorbidity,and complications,as well as arterial blood gas analysis results at admission of neonatal ICU were compared between the two groups.The risk factors for adverse prognosis of neonates with severe asphyxia were analyzed by using multivariate Logistic regression model.The value of arterial blood gas analysis indices in predicting prognosis of neonates with severe asphyxia was analyzed by employing receiver operating characteristic(ROC)curve.Results(1)Neonates in the failure group obtained higher proportions of amniotic fluid pollution inⅢdegree,tracheal intubation during recovery,comatose state at admission,and higher incidence rates of cardiac damage,pulmonary hemorrhage,acute kidney injury,multiple organ dysfunction syndrome(MODS),hyperglycemia and thrombocytopenia as compared with the success group,whereas lower 5 minutes Apgar score after birth,pH value,PaO_(2),and a lower level of bicarbonate ion,as well as a lower base excess value as compared with the success group(all P<0.05).(2)The results of multivariate Logistic regression analysis revealed that comatose state at admission,and the occurrence of pulmonary hemorrhage,acute kidney injury,MODS,as well as low pH value,low PaO_(2),low base excess value were the risk factors for adverse prognosis of neonates with severe asphyxia(all P<0.05),and pH value,PaO_(2),and base excess values exerted predictive value on prognosis of neonates with severe asphyxia to a certain extent.Conclusion For neonates with severe asphyxia undergoing invasive mechanical ventilation therapy,comatose state at admission,and the occurrence of pulmonar

关 键 词：重度窒息 新生儿 有创机械通气 危险因素 预后 

分 类 号：R722.1[医药卫生—儿科]