重度窒息新生儿55例预后分析  

Prognostic analysis of 55 neonates with severe asphyxia

作　　者：文彩荷 俞黎铭 柴芸 WEN Caihe;YU Liming;CHAI Yun(Department of Obstetrics,Hangzhou Women's Hospital,Hangzhou,Zhejiang 310008,China)

机构地区：[1]杭州市妇产科医院产科,浙江杭州310008

出　　处：《预防医学》2023年第10期899-902,共4页CHINA PREVENTIVE MEDICINE JOURNAL

基　　金：杭州市农业与社会发展科研引导项目(20220919Y026)。

摘　　要：目的 了解重度窒息新生儿预后情况,为改善重度窒息新生儿预后提供依据。方法 选择2016—2021年在杭州市妇产科医院出生的重度窒息新生儿为研究对象,收集新生儿出生体重、性别、Apgar评分、出生后30 min内动脉血pH值及产妇分娩资料。患儿出生1年后进行门诊随访,采用Gesell发育诊断量表评价预后情况,死亡或发育商(DQ)<75分为预后不良,比较预后良好组与预后不良组临床特征。结果 纳入重度窒息新生儿55例,其中男婴26例,女婴29例;出生体重M (QR)为2 845.00 (1 948.00) g。产妇52人(3人为双胎妊娠),年龄为(30.56±4.08)岁;难产35人,占67.31%;初产妇37人,占71.15%。重度窒息新生儿预后良好40例,占72.73%;预后不良15例,占27.27%,其中死亡13例,DQ<75分2例。预后良好组产妇胎位异常发生率为36.84%,高于预后不良组的0%(P<0.05);预后不良组产妇子宫扭转或子宫破裂发生率为21.43%,高于预后良好组的0%(P<0.05);预后不良组患儿的5 min Apgar评分M(QR)为3.00 (4.00)分,出生后30 min内动脉血p H值为6.93±0.23,均低于预后良好组的6.00 (4.00)分和7.23±0.15(P<0.05)。结论 产妇子宫扭转或子宫破裂、5 min Apgar评分低和出生后30 min内动脉血pH值低可能增加重度窒息新生儿的不良预后风险。Objective To analyze the prognosis of neonates with severe asphyxia,so as to provide insights into improve⁃ments of prognosis among neonates with severe asphyxia.Methods Neonates with severe asphyxia born in Hangzhou Women's Hospital from 2016 to 2021 were recruited,and neonates'birth weight,gender,Apgar score,arterial blood pH value within 30 minutes after birth and maternal delivery data were collected.Outpatient follow-up was performed among neonates one year after birth,and the prognosis was evaluated with the Gesell Developmental Scale.Death or de⁃velopment quotient(DQ)of<75 was defined poor prognosis,and the clinical characteristics were compared between the good prognosis group and the poor prognosis group.Results A total of 55 neonates with severe asphyxia were en⁃rolled,including 26 boys and 29 girls,with a median birth weight of 2845.00 g(interquartile range,1948.00 g).There were 52 lying-in women(3 women had twins),with a mean age of(30.56±4.08)years,including 35 women with dystocia(67.31%)and 37 primiparas(71.15%).Of 55 neonates with severe asphyxia,there were 40 neonates with good prognosis(72.73%)and 15 neonates with poor prognosis(27.27%),including 13 deaths and 2 cases with DQ of<75.The incidence of abnormal fetal position was higher in the good prognosis group than in the poor prognosis group(36.84%vs.0%;P<0.05),and the incidence of uterine torsion or uterine rupture was higher in the poor prognosis group than in the good prognosis group(21.43%vs.0%;P<0.05).The median Apgar score at 5 min after birth and ar⁃terial blood pH within 30 min after birth were lower in the poor prognosis group[3.00(interquartile range,4.00)points and (6.93±0.23)] than in the good prognosis group [6.00 (interquartile range, 4.00) points and (7.23±0.15)] (P<0.05).Conclusion Maternal uterine torsion or uterine rupture, low Apgar score at 5 min after birth, and low arterial bloodpH within 30 min after birth may aggravate the poor prognosis among neonates with severe asphyxia.

关 键 词：新生儿重度窒息 预后 APGAR评分 动脉血pH值 

分 类 号：R722.12[医药卫生—儿科]