不同救治态度对超早产儿生存的影响及不良临床结局危险因素分析:一项回顾性真实世界研究  

Impact of different treatment attitudes on survival and risk factors for poor clinical outcomes in extremely preterm infants:a retrospective real-world study

作　　者：李萌萌[1] 李书书 钱苗[1] 张敏[1] 韩树萍[1] LI Meng-Meng;LI Shu-Shu;QIAN Miao;ZHANG Min;HAN Shu-Ping(Department of Pediatrics,Women's Hospital of Nanjing Medical University/Nanjing Women and Children's Healthcare Hospital,Nanjing 210004,China)

机构地区：[1]南京医科大学附属妇产医院/南京市妇幼保健院儿科,江苏南京210004

出　　处：《中国当代儿科杂志》2025年第3期269-278,共10页Chinese Journal of Contemporary Pediatrics

基　　金：国家自然科学基金面上项目(82271744);江苏省卫生健康委员会省妇幼保健项目(F202309);南京医科大学科技发展基金(NMUB20220094);南京市卫生科技发展专项资金项目(YKK21160)。

摘　　要：目的探究不同救治态度对超早产儿(extremely preterm infants,EPI)生存现状的影响,评估积极救治患儿的死亡及严重并发症的发生情况及其高危因素。方法回顾性分析2016年1月1日—2023年12月31日出生并于生后24 h内入住南京医科大学附属妇产医院新生儿重症监护病房的EPI的围生期资料,分析救治态度对不同出生胎龄和出生体重人群死亡的归因风险,利用多因素logistic回归模型分析积极救治组死亡及严重并发症发生的危险因素。结果共纳入485例EPI。随着出生胎龄或出生体重的增加,消极治疗死亡归因风险比升高;积极治疗可明显改善出生胎龄≥24周的EPI生存现状。多因素logistic回归分析显示,出生胎龄较低、生后72 h内需机械通气是EPI死亡或合并严重并发症的独立危险因素(P<0.05)。结论积极救治可明显延长出生胎龄≥24周EPI的生存时间;出生胎龄较低、生后72 h内需机械通气与EPI不良生存结局密切相关。Objective To explore the impact of different treatment attitudes on the survival status of extremely preterm infants(EPIs)and evaluate the mortality and occurrence of severe complications in actively treated infants,as well as their risk factors.Methods A retrospective analysis was conducted on perinatal data of EPIs born between January 1,2016,and December 31,2023,who were admitted to the neonatal intensive care unit of Nanjing Women and Children's Healthcare Hospital within 24 hours after birth.The analysis focused on the attributable risk of mortality associated with different treatment attitudes in EPIs of varying gestational ages and birth weights.A multivariate logistic regression model was used to analyze the risk factors for mortality and severe complications in the actively treated group.Results A total of 485 EPIs were included.As gestational age or birth weight increased,the attributable risk of mortality with care withdrawal increased.Active treatment significantly improved the survival status of EPIs born at a gestational age of≥24 weeks.Multivariate logistic regression analysis indicated that lower gestational age and the need for mechanical ventilation within 72 hours after birth were independent risk factors for mortality or severe complications in EPIs(P<0.05).Conclusions Active treatment can significantly extend the survival time of EPIs born at a gestational age of≥24 weeks.Lower gestational age and the need for mechanical ventilation within 72 hours after birth are closely associated with poor survival outcomes in EPIs.

关 键 词：积极治疗 死亡 并发症 危险因素 超早产儿 

分 类 号：R722.6[医药卫生—儿科]