新生儿胎粪吸入综合征临床结局的影响因素分析  

Analysis of clinical outcomes and related factors of meconium aspiration syndrome in neonates

作　　者：刁艳霞[1] 徐倩倩 沈怀云[1] DIAO Yan-xia;XU Qian-qian;SHEN Huai-yun(Department of Pediatrics,The First Affiliated Hospital of Bengbu Medical College,Bengbu Anhui 233004,China)

机构地区：[1]蚌埠医学院第一附属医院儿科,安徽蚌埠233004

出　　处：《蚌埠医学院学报》2023年第7期905-909,共5页Journal of Bengbu Medical College

基　　金：安徽省卫生计生委科研计划项目(2016QKO44);蚌埠医学院自然科学研究重点项目(2021byzd150)。

摘　　要：目的:分析胎粪吸入综合征(MAS)新生儿临床结局及影响因素。方法:回顾性分析80例MAS新生儿临床资料,根据预后情况分为轻症组和重症组。比较2组临床资料,多因素logistic回归法分析影响MAS患儿预后不良的危险因素,分析MAS患儿并发症发生情况及主要并发症的危险因素。结果:80例患儿中,14例放弃治疗或死亡,预后不良率为17.50%。重症组胎龄>40周、窒息史、羊水Ⅲ度污染、胎盘异常、出生5 min Apgar评分≤7分、剖宫产、胸片分度中重度占比均高于轻症组(P<0.05~P<0.01),重症组出生1 min Apgar评分、出生后立即经呼吸道清理吸出胎粪、机械辅助通气、补充益生菌比例均低于轻症组(P<0.05~P<0.01)。多因素logistic回归分析结果显示,孕周>40周、窒息史、羊水Ⅲ度污染、出生5 min Apgar评分<7分为MAS患儿预后不良的危险因素(P<0.05~P<0.01),出生后立即经呼吸道清理吸出胎粪、机械辅助通气、补充益生菌为保护因素(P<0.05~P<0.01)。MAS患儿并发症以缺血缺氧性脑病(43/80,53.75%)、呼吸衰竭(38/80,48.75%)、肺动脉高压(32/80,40.00%)、代谢性酸中毒(28/80,35.00%)为主。单因素及多因素logistic回归分析显示,孕周>40周、孕妇高龄、羊水Ⅲ度污染、胎儿窒息史为MAS患儿并发缺血缺氧性脑病的主要危险因素(P<0.05~P<0.01),而出生后立即经呼吸道清理吸出胎粪为保护因素(P<0.05)。结论:MAS新生儿可能受胎龄、羊水污染、窒息史、Apgar评分等影响而放弃治疗或院内死亡,出生后立即经呼吸道清理吸出胎粪、机械辅助通气、补充益生菌有助于改善临床结局,减少并发症风险。Objective:To analyze the clinical outcomes and related factors of meconium aspiration syndrome(MAS)in neonates.Methods:The clinical data of 80 neonates with MAS were retrospectively analyzed.According to the prognosis,they were divided into mild group and severe group.The clinical data were compared between the two groups,the risk factors that affected the poor prognosis of MAS were analyzed by multivariate logistic regression,and the incidence of complications and risk factors of major complications in MAS neonates were analyzed.Results:Among the 80 neonates,14 gave up treatment or died,with a poor prognosis rate of 17.50%.The proportion of fetal age>40 weeks,asphyxia history,amniotic fluidⅢ°pollution,placental abnormalities,Apgar score≤7 points at 5 min of birth,cesarean section,chest X-ray grading in the severe group was higher than those in the mild group(P<0.05 to P<0.01),and the proportion of Apgar score at 1 min of birth,meconium aspiration through respiratory tract immediately after birth,mechanical ventilation,probiotics supplementation in the severe group was lower than those in the mild group(P<0.05 to P<0.01).Multivariate logistic regression analysis showed that gestational age>40 weeks,asphyxia history,amniotic fluidⅢ°pollution,Apgar score<7 points at 5 min of birth were the risk factors for poor prognosis in MAS neonates(P<0.05 to P<0.01),and immediately clearing meconium through respiratory tract after birth,mechanical ventilation,probiotics supplementation were the protective factors(P<0.05 to P<0.01).The main complications of MAS neonates were hypoxic-ischemic encephalopathy(43/80,53.75%),respiratory failure(38/80,48.75%),pulmonary arterial hypertension(32/80,40.00%)and metabolic acidosis(28/80,35.00%).Univariate and multivariate logistic regression analysis showed that gestational age>40 weeks,elderly age of pregnant women,amniotic fluidⅢ°pollution,and history of fetal asphyxia were the main risk factors for MAS neonates complicated with hypoxic-ischemic encephalopathy(P<0.05 to P<0.0

关 键 词：胎粪吸入综合征 临床结局 新生儿 

分 类 号：R722.1[医药卫生—儿科]