胎龄<32周双胎早产儿娩出顺序对近期临床结局的影响  

Impact of delivery order on short-term clinical outcomes of preterm twins born before 32 weeks of gestation

作　　者：刘倩妤 宋思捷 谢茜[1] 吴艳[1] Liu Qianyu;Song Sijie;Xie Qian;Wu Yan(Department of Pediatrics,Chongqing Health Center for Women and Children(Women and Children's Hospital of Chongqing Medical University),Chongqing 401147,China)

机构地区：[1]重庆市妇幼保健院(重庆医科大学附属妇女儿童医院)儿一科,重庆401147

出　　处：《中华围产医学杂志》2024年第12期1015-1023,共9页Chinese Journal of Perinatal Medicine

基　　金：重庆市妇幼科研培育项目(2021FY109);重庆市自然科学基金面上项目(cstc2020jcyj-msxmX0528);重庆市科卫联合医学科研项目青年项目(2023QNXM037)。

摘　　要：目的探讨娩出顺序对胎龄<32周双胎早产儿近期临床结局的影响。方法回顾性分析2018年1月至2022年12月收住重庆市妇幼保健院(重庆医科大学附属妇女儿童医院)新生儿救治中心的胎龄<32周的双胎早产儿的临床资料。按照娩出顺序不同分为先娩出组与后娩出组。分析娩出顺序对双胎早产儿产房过渡期复苏支持措施及结局、新生儿重症监护病房内呼吸支持模式及治疗、严重并发症(有血流动力学意义的动脉导管未闭、新生儿坏死小肠结肠炎≥Ⅱ期、早发和晚发型脓毒症、早产儿视网膜病变和颅内出血)和死亡率的影响。再将2组按绒毛膜性质和分娩方式分别进行亚组分析。采用配对t检验、秩和检验和McNemar's检验(配对χ^(2)检验)进行统计学分析。结果(1)共296例(148对)早产儿纳入研究。后娩出组1 min Apgar评分≤7分的比例高于先娩出组[27.7%(41/148)与17.6%(26/148),χ^(2)=5.94,P=0.015];但2组出生体重、脐动脉血pH<7.2的比例、生后5 min Apgar评分、气管插管、产房肺表面活性物质(pulmonary surfactant,PS)使用率、胸外按压和/或肾上腺素使用比例等项目差异无统计学意义。不同绒毛膜性质和分娩方式亚组下,先、后娩出组1 min Apgar评分≤7分的差异亦无统计学意义。(2)先娩出组和后娩出组新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)的总体发病率差异无统计学意义,但后娩出组NRDSⅢ~Ⅳ期发病率高于先娩出组[27.0%(40/148)和16.9%(25/148),χ^(2)=5.94,P=0.015]。2组间PS单次使用比例及>2剂次使用比例、机械通气比例及总时长,以及支气管发育不良的发病率差异均无统计学意义。双羊膜囊双胎中,后娩出组患呼吸衰竭和NRDSⅢ~Ⅳ期发病率高于双胎先娩出组[87.4%(104/119)与79.8%(95/119),配对χ^(2)检验,P=0.035;27.7%(33/119)与17.6%(21/119),χ^(2)=4.03,P=0.045]。阴道分娩和剖宫产亚组中,后娩出组NRDSⅢ~Ⅳ期ObjectiveTo investigate the impact of delivery orders on the short-term clinical outcomes of preterm twins born before 32 weeks of gestation.MethodsA retrospective analysis was conducted on the clinical data of preterm twins born before 32 weeks of gestation who were admitted to the Neonatology Department of Women and Children's Hospital of Chongqing Medical University from January 2018 to December 2022.The twins were divided into two groups based on the order of delivery:the first-born group and the second-born group.The study analyzed the impact of delivery orders on resuscitation support measures and outcomes during the transition period in the delivery room,respiratory support modes and treatments in the neonatal intensive care unit(NICU),severe complications(hemodynamically significant patent ductus arteriosus,neonatal necrotizing entercolitis≥stageⅡ,early-and late-onset sepsis,retinopathy of prematurity,and intracranial hemorrhage),and mortality.Subgroup analyses were also conducted based on chorionicity and mode of delivery.Statistical analyses were performed using paired t-tests,rank-sum tests,and McNemar's tests(paired Chi-square tests).Results(1)A total of 296 cases(148 pairs)of preterm twins born before 32 weeks of gestation were included in the study.The proportion of 1-minute Apgar scores≤7 was higher in the second-born group compared to the first-born group[27.7%(41/148)vs.17.6%(26/148),χ^(2)=5.94,P=0.015];however,there were no statistically significant differences between the two groups in terms of the proportion of umbilical artery blood gas pH<7.2,5-minute Apgar scores,intubation,use of pulmonary surfactant(PS)in the delivery room,chest compressions,birth weight,and/or adrenaline use.There were also no statistically significant differences in 1-minute Apgar scores≤7 between the first-born and second-born groups when analyzed by chorionicity and mode of delivery.(2)There was no statistically significant difference in the overall incidence of neonatal respiratory distress syndrome(NRDS)bet

关 键 词：分娩 婴儿 早产 妊娠 双胎 呼吸窘迫综合征 新生儿 

分 类 号：R722.6[医药卫生—儿科]