影响新生儿硬肿症预后的危险因素探讨

Explore the rist factor of prognosis of sclerema neonatorum.

目的探讨影响新生儿硬肿症预后的危险因素。方法对1994年3月至2004年3月收治的148例新生儿硬肿症患儿进行回顾性分析。结果治愈67例(4527%),好转38例(2568%),放弃8例(541%),死亡35例(2365%)。单因素分析发现新生儿硬肿症病死组较治愈组合并或并发败血症、颅内出血、坏死性小肠结肠炎、肺出血、高血糖、代谢性酸中毒、休克、全心衰、DIC、肾功能衰竭、呼吸衰竭、中毒性脑病发生率高(P<005)。治愈组白细胞≤5×109/L或≥20×109/L发生率为2537%,病死组为5143%(χ2=6924,P<001)。治愈组血小板(PLT)≤100×109/L发生率为1940%,病死组为600%(χ2=17051,P<0001)。治愈组低体温轻度、重度发生率分别为8958%、1044%,病死组分别为4286%、5714%(χ2=2575,P<0001)。治愈组硬肿面积轻度、重度发生率分别为8507%、1493%,病死组分别为4571%、5429%(χ2=17504,P<0001)。Logistic回归分析显示颅内出血、坏死性小肠结肠炎、高血糖、休克、PLT≤100×109/L是影响新生儿硬肿症预后的危险因素。结论积极防治新生儿硬肿症各种合并症及并发症,有助于降低其病死率。

Objective:To explore the rist factor of prognosis of sclerema neonatorum.Methods:148 cases of sclerema neonatorum were admitted from March 1994 to March 2004 and were analyzed retrospectively.Results:67 cases(45 27%)were cured,38 cases(25 68%)improved after treatment,8 cases(5 41%)gave up treatment,35 cases(23 65%)died.Simple factor analysis showed that the death group infants were higher in combination or complicated syndrome than the cured group in the sepsis,intracranial hemorrhage,neonatal necrotizing enterocolitis,pneumorrhagia,hyperglycemia,metabolic acidosis,shock,heart failure,DIC,kidney failure,respiratory failure,toxic encephalopathy(P<0 05).Leucocyte≤5×10 9/L or ≥20×10 9/L was 25 37% in the cure group,and 51 43% in the death group(χ 2=6 924,P<0 01).The platelet≤100×10 9/L was 19 40% in the cure group,and 60 0% in the death group (χ 2=17 051,P<0 001).The mild,severe hypothermia was 89 58%、10 44% and 42 86%、57 14% in the death group respectively(χ 2=25 75,P<0 001).The mild,severe sclerema area was 85 07%,14 93% in the cured group respectively,and 45 71%、54 29% in the death group(χ 2=17 504,P<0 001) The logistic regression showed that the multiple rist factors of influence on prognoss of sclerema neonatorum included intracranial hemorrhage,neonatal necrotizing enterocolitis,hyperglycemia,shock,platelet≤100×10 9/L.Conclusions:Avoiding multiple rist fastors episode and active treatment of the combination or complication syndromes can reduce the mortality of sclerema neonatorum.