新生儿重度窒息器官损害及死亡危险因素分析(英文)

Organ-system injuries and risk factors related to mortality in neonates with severe birth asphyxia

目的回顾性分析我院170例新生儿重度窒息的临床情况及各脏器受累损伤程度,了解与死亡有关的危险因素。方法对1993～2004年我院NICU收治的重度窒息新生儿170例资料进行分析,用SAS软件对与死亡有关危险因素进行OR分析。结果170例中死亡22例(12.5%),165例(97.1%)出现各脏器的并发症,各脏器受累机会的次序依次为中枢神经系统,肺,代谢系统等;严重程度依次为代谢,肺,中枢神经系统等。与死亡有关的危险因素依次为中枢神经系统严重受累,1个以上脏器严重受损,呼吸衰竭,代谢紊乱,电解质紊乱,血气异常,肺损害,10分钟Apgar评分≤3,胎龄<37周,肝脏损害,心脏损害,PCO2增高和血液系统损伤。结论器官/系统损害是除HIE外新生儿重度窒息的主要并发症,严重威胁生命并且可以导致死亡;对于一些造成死亡的危险因素应该引起重视和早期干预。

Objective To analyze the effects of severe neonatal asphyxia on various organ-systems and to identify the risk factors associated with the resultant injuries and death. Methods The data of 170 cases in the last 10 years from January 1993 to March 2004 were analyzed. The risk factors associated with death were subjected to odds ratio （OR） analysis with the SAS software. Results There were 22 deaths in the 170 cases （ 12.5% ）. Organ-system injuries were evident in 165 of 170 cases （97. 1% ）. In descending orders, the organ-system injuries were central nervous system [ CNS,66.5% （113/170） ], pulmonary [ 62.9% （107/170） ] and metabolic disorders [ 50.6% （86/170） ]. The severity of injuries was in the reversed orders from metabolic disorders, pulmonary to CNS. From high risk to low, the factors which affected the mortality of severe asphyxia were, in order, severe CNS injury, ≥ 1 organ/system injury, respiratory failure, metabolic abnormality, electrolyte imbalance, blood-gas abnormality, pulmonary involvement, lO min Apgar score ≤ 3, gestational age 〈 37 weeks, hepatic involvement, cardiac involvement, raised PCO2, and hematologic involvement. Conclusious Organ-system injuries in addition to hypoxic-ischemic encephalopathy （ HIE ） were complications found in the majority of the cases with severe neonatal asphyxia. The risk factors such as CNS injury or HIE, pulmonary dysfunction and failure, and multiorgan dysfunction syndrome （MODS） involving more than three organ-systems should be detected and recognized early so that early intervention can be instituted to reduce the mortality.