窒息复苏后全身炎症反应综合征与新生儿脑损伤程度及预后的关系

Relationship between systemic inflammatory response syndrome and degree of brain damage and prognosis following severe asphyxia in neonates after asphyxia treated by resuscitation

目的:探讨窒息复苏后SIRS与新生儿脑损伤程度及预后的关系。方法:1999年1月～2004年12月本院NICU收治的符合SIRS诊断标准有重度窒息史的足月新生儿52例(SIRS组),另取同期NICU中不伴SIRS的重度窒息复苏后足月新生儿40例作为对照组(非SIRS组)。所有患儿在生后72h内收集SIRS所需资料;并于生后24h内进行新生儿危重病例评分。在生后72h左右进行HIE的临床分度;7～10d行头颅CT检查并分度;12～14d进行新生儿行为神经测定(NBNA)评分;并统计各组病死率。结果:随着SIRS符合项数的增加,危重病例所占比例显著增加(χ2=6.4792,P<0.05),病死率也明显增加(χ2=14.7713,P<0.001)。非SIRS组与SIRS组比较,前者危重病例所占比例明显低于后者(χ2=8.7917,P<0.01),前者的病死率亦显著低于后者(χ2=11.0318,P<0.001)。SIRS组重度HIE发生率显著高于非SIRS组(χ2=18.5320,P<0.01)。存活者NBNA评分<35分者所占比例SIRS组显著高于非SIRS组(χ2=4.3905,P<0.05)。CT检查脑白质低密度分布呈中、重度改变者所占比例SIRS组亦明显高于非SIRS组(χ2=4.6316,P<0.05)。结论:在窒息复苏后的新生儿,SIRS的发生与窒息复苏后新生儿疾病的演变及预后具有明显的相关性。随着SIRS符合项数的增加,危重病例所占比例及病死率也明显增加。SIRS的发生可在一定程度上反映窒息缺氧对脑的损伤程度以及预后。

Objective： To study relationship between systemic inflammatory response syndrome （SIRS） and degree of brain damage and prognosis following severe asphyxia in neonates after asphyxia treated by resuscitation. Methods： 52 full - term neonates with severe asphyxia and SIRS admitted to this NICU （SIRS group） were reviewed retrospectively from jan. 1999 to Dec. 2004, and 40 neonates with severe asphyxia and non - SIRS during this period wero selected as control group （ non - SIRS group） . Data about the SIRS diagnostic criteria were collected in all patients within the first 72 hours after birth, and all patients were scored within the 24 hours after birth according to the criteria of the Critical - score - system for neonatal acute severity. The degree of hypoxic - ischemic encephalopathy （HIE） was also evaluated, and the Neonatal Behavioral Neurological Assessment （NBNA） was done. The mortality were also observed in both groups. Results： The percentage of critical cases and mortality rate in SIRS newborns increased with increasing items of criteria for diagnosis of SIRS （x^2 = 8. 791 7, P 〈0. 01; x^2 =11. 031 8, P 〈0. 01 respectively） . The incidence of severe HIE was also significantly higher in the SIRS group than that in the non - SIRS group （x^2 = 18. 532 0, P 〈 0. 01 ） . The percentage of the survivors whose NBNA marks were less than 35 at 12 - 14 d after birth in the SIRS group was much higher than that in the non - SIRS group （x^2 = 4. 390 5, P 〈 0. 05） . Conclusion： The occurrence of SIRS remarkably correlated with the development of the disease following asphyxia and the outcome of the illness. The newborns with SIRS following asphyxia might have more severe brain damage and their prognoses might be more undesirable.