新生儿窒息复苏后合并脑损伤的影响因素分析  

Analysis of influencing factors on brain injury after neonatal asphyxia resuscitation

作　　者：王茹 康会玲 李艳超 Wang Ru;Kang Huiling;Li Yanchao(Department of Neonatology,Shijiazhuang Maternal and Child Health Hospital,Shijiazhuang 050000,China)

机构地区：[1]石家庄市妇幼保健院新生儿科,石家庄050000

出　　处：《中国医师进修杂志》2025年第3期250-256,共7页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨新生儿窒息复苏后患儿合并脑损伤的影响因素。方法回顾性分析2017年1月至2024年1月石家庄市妇幼保健院180例新生儿窒息患儿的临床资料,患儿均给予复苏治疗。按7∶3比例将其分为建模组(126例)和验证组(54例)。建模组患儿中,合并脑损伤51例(脑损伤亚组),未合并脑损伤75例(无脑损伤亚组)。记录患儿的一般资料,连续变量采用受试者工作特征(ROC)曲线确定最佳截断值。采用多因素Logistic回归分析影响新生儿窒息复苏后患儿合并脑损伤的独立危险因素;采用R语言软件"rms"包构建预测新生儿窒息复苏后患儿合并脑损伤的列线图模型,以校正曲线对列线图模型进行内部验证,以决策曲线、ROC曲线评估列线图模型的预测效能。结果建模组与验证组一般资料比较差异无统计学意义(P>0.05)。脑损伤亚组胎龄<37周比例、重度窒息比例、Ⅱ~Ⅲ度羊水污染比例、宫内窘迫比例和血乳酸明显高于无脑损伤亚组[60.78%(31/51)比38.67%(29/75)、37.25%(19/51)比17.33%(13/75)、27.45%(14/51)比10.67%(8/75)、47.06%(24/51)比26.67%(20/75)和(2.64±0.61)mmol/L比(2.21±0.56)mmol/L],差异有统计学意义(P<0.05或<0.01);两组性别构成、出生体质量、母亲年龄、母亲不良孕产史、分娩方式、产次、羊水量异常、胎位异常、脐带异常、胎盘异常、收缩压、舒张压、体温和血糖比较差异无统计学意义(P>0.05)。ROC曲线分析结果显示,血乳酸最佳截断值为2.59 mmol/L。多因素Logistic回归分析结果显示,胎龄小、重度窒息、羊水Ⅱ~Ⅲ度污染、宫内窘迫和高血乳酸是影响新生儿窒息复苏后患儿合并脑损伤的独立危险因素(OR=2.854、3.428、3.405、3.427和7.844,95%CI 1.166~6.983、1.263~9.305、1.076~10.768、1.358~8.645和3.080~19.978,P<0.05或<0.01)。以胎龄、窒息程度、羊水污染、宫内窘迫和血乳酸作为预测因子构建列线图模型。校正曲线分析结果显示,此�Objective To explore the influencing factors of brain injury in children with neonatal asphyxia after resuscitation.Methods The clinical data of 180 children with neonatal asphyxia from January 2017 to January 2024 in Shijiazhuang Maternal and Child Health Hospital were retrospectively analyzed,and all children were received resuscitation treatment.The children were divided into modeling group(126 cases)and validation group(54 cases)in a 7∶3 ratio.Among the children in modeling group,51 children combined brain injury(brain injury subgroup),and 75 children did not combine brain injury(non-brain injury subgroup).The general data were recorded,and the continuous variables were determined by the receiver operating characteristic(ROC)curve to determine the optimal cut-off value.Multivariate Logistic regression analysis was used to analyze the independent risk factors of brain injury in children with neonatal asphyxia after resuscitation.The R language software"rms"package was used to construct a nomogram model for predicting brain injury in children with neonatal asphyxia after resuscitation.The nomogram model was internally verified by the calibration curve,and the prediction efficiency of the nomogram model was evaluated by the decision curve and ROC curve.Results There was no statistical difference in general data between modeling group and validation group(P>0.05).The gestation age<37 weeks proportion,severe asphyxia proportion,ⅡtoⅢgrade amniotic fluid contamination proportion,intrauterine distress proportion and blood lactate in brain injury subgroup were significantly higher than those in non-brain injury subgroup:60.78%(31/51)vs.38.67%(29/75),37.25%(19/51)vs.17.33%(13/75),27.45%(14/51)vs.10.67%(8/75),47.06%(24/51)vs.26.67%(20/75)and(2.64±0.61)mmol/L vs.(2.21±0.56)mmol/L,and there were statistical differences(P<0.05 or<0.01);there were no statistical differences in gender composition,birth weight,maternal age,maternal history of adverse pregnancy and childbirth,mode of delivery,parity,abnormal amniotic f

关 键 词：新生儿窒息 脑损伤 影响因素分析 列线图 

分 类 号：R72[医药卫生—儿科]