超未成熟儿的生存状况与预后影响因素分析

崔银珠; 张谦慎; 贺红云; 陈春

doi:10.7499/j.issn.1008-8830.2014.06.007

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中国当代儿科杂志 ›› 2014, Vol. 16 ›› Issue (6) : 596-600. DOI: 10.7499/j.issn.1008-8830.2014.06.007

论著·临床研究

超未成熟儿的生存状况与预后影响因素分析

崔银珠, 张谦慎, 贺红云, 陈春

作者信息 +

Analysis of survival and prognostic factors in extremely preterm infants

CUI Yin-Zhu, ZHANG Qian-Shen, HE Hong-Yun, CHEN Chun

Author information +

Neonatal Intensive Care Unit, Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong 518028, China

Aboat authors:

[1] 王卫平. 儿科学[M]. 第8 版. 北京: 人民卫生出版社, 2013: 93.
[2] 邵肖梅, 叶鸿瑁, 丘小汕, 等. 《实用新生儿学》[M]. 第4 版. 北京: 人民卫生出版社, 2011.
[3] The Canadian Neonatal Network Annual Report 2009 Rapport Annuel[R]. 2009.
[4] Barbara J, Stoll BJ, Hansen NI, et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network[J].Pediatrics, 2010 126(3): 443-456.
[5] 李娟, 王庆红, 吴红敏, 等. 2005 年中国城市产科新生儿出生状况调查[J].中国当代儿科杂志, 2012, 14(1): 7-10.
[6] Kugelman A, Bader D, Lerner-Geva L, et al. Poor outcomes at discharge among extremely premature infants: a national population-based study[J].Arch Pediatr Adolesc Med, 2012, 166(6): 543-550.
[7] Mori R K S F M. Neonatal Research Network Japan. Antenatal Corticosteroids Promote Survival of Extremely Preterm Infants Born at 22 to 23 Weeks of Gestation[Z]. 2011.159, 110-114.
[8] Miracle X, Di Renzo GC, Stark A, et al. Guideline for the use of antenatal corticosteroids for fetal maturation[J].J Perinat Med, 2008, 36(3): 191-196.
[9] Tagare A, Chaudhari S, Kadam S, et al. Mortality and morbidity in extremely low birth weight (ELBW) infants in a neonatal intensive care unit[J].Indian J Pediatr, 2013, 80(1): 16-20.
[10] 邓寅业, 李柳青, 陆元奉. 126 例极低及超低出生体重儿临床高危因素分析[J].国外医药( 抗生素分册), 2012(2): 91-94.
[11] 龚元杰. 产前糖皮质激素治疗对早产儿神经系统发育影响的 Meta 分析[D]. 重庆医科大学学位论文, 2011.
[12] 林新祝, 陈涵强, 郑直, 等. 早期口服布洛芬治疗极低出生体重儿动脉导管未闭的临床研究[J].中国当代儿科杂志, 2012, 14(7): 502-505.
[13] Austeng D, Kallen K B, Ewald U W, et al. Incidence of retinopathy of prematurity in infants born before 27 weeks' gestation in Sweden[J].Arch Ophthalmol, 2009, 127(10): 1315-1319.

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文章历史 +

摘要

目的探讨胎龄28 周以下超未成熟儿在新生儿重症监护病房（NICU）的存活率、住院期间并发症发生情况及其预后。方法收集2011 年1 月至2013 年3 月入住NICU 的胎龄<28 周早产儿90例，回顾性分析围产期资料、出生及复苏史、住院期间通气/ 氧疗情况，以及严重脑室内出血（IVH）、支气管肺发育不良（BPD）、早产儿视网膜病（ROP）、动脉导管未闭（PDA）、败血症等的发生率。结果 90 例患儿平均胎龄26±1 周，出生体重898±165 g，总存活率为57%，病死率9%，放弃率34%。常见并发症包括新生儿呼吸窘迫综合征（RDS）88%、BPD 85%、PDA 69%， ROP 68%，Ⅲ、Ⅳ级IVH 31%；存活早产儿平均住院时间为83±18 d，出院平均体重为2419±300 g。多因素logistic 回归分析发现，肺出血与严重IVH 为死亡或放弃的高危因素，产前使用糖皮质激素为保护因素。结论目前国内超未成熟儿存活率相比发达国家仍有较大差距；肺出血、严重IVH 为影响预后的重要因素。

Abstract

Objective To investigate the survival rate, complications during hospitalization, and prognostic factors in extremely preterm infants (gestational age less than 28 weeks) in the neonatal intensive care unit (NICU). Methods A retrospective analysis was performed on 90 extremely preterm infants who were admitted to the NICU between January 2011 and March 2013 to investigate the perinatal data, delivery and resuscitation, ventilation/ oxygen supply during hospitalization, mortality, and the incidence of severe (grade III/IV) intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), patent ductus arteriosus (PDA), and septicemia. Results Among the 90 extremely preterm infants, the gestational age, birth weight, overall survival rate, mortality, and withdrawal rate were 26±1 weeks, 898±165 g, 57%, 9%, and 34%, respectively. The incidence rates of neonatal respiratory distress syndrome, BPD, PDA, ROP, and grade III/IV IVH were 88%, 85%, 69%, 68%, and 31%, respectively. The surviving infants had a mean length of hospital stay of 83±18 days and a mean weight at discharge of 2419±300 g. The multivariate logistic regression analysis showed that grade III/IV IVH and pulmonary hemorrhage were high-risk factors for death or withdrawal, while antenatal corticosteroids were the protective factor for outcome (P<0.05). Conclusions The survival rate of extremely preterm infants is still much lower than that in developed countries. grade III/IV IVH, and pulmonary hemorrhage are important prognostic factors.

导出引用

崔银珠, 张谦慎, 贺红云, 陈春. 超未成熟儿的生存状况与预后影响因素分析[J]. 中国当代儿科杂志. 2014, 16(6): 596-600 https://doi.org/10.7499/j.issn.1008-8830.2014.06.007

CUI Yin-Zhu, ZHANG Qian-Shen, HE Hong-Yun, CHEN Chun. Analysis of survival and prognostic factors in extremely preterm infants[J]. Chinese Journal of Contemporary Pediatrics. 2014, 16(6): 596-600 https://doi.org/10.7499/j.issn.1008-8830.2014.06.007