救治12例超低出生体重儿体会

Experience from perinatal management of 12 extremely low birth weight infants

目的探讨在新生儿重症监护病房（neonatal intensive care unit，NICU）救治超低出生体重儿（extremely low birth weight infant，ELBWI）的过程中，不断提高存活率及减少后遗症的关键问题。方法对于2000年1月至2006年4月间我院收治的12例ELBWI的临床资料进行回顾性分析，总结救治工作的经验体会。结果（1）近3年ELBWI存活率（4／5）较前4年（4／7）明显增高；救治成活者最小胎龄25周，出生体重650g。（2）支气管肺发育不良、颅内出血和脑室周围白质软化等是造成严重后遗症的主要原因；呼吸、感染、内环境紊乱仍是ELBWI死亡的主要原因。（3）近3年没有出现早产儿视网膜病、新生儿坏死性小肠结肠炎、核黄疸等ELBWI易发生的并发症。结论ELBWI的管理是一个系统工程，一个团队整体水平的体现，既要提高存活率又要提高患儿的生存质量。因此，必须注重产前、产时及出生后产、儿科的密切配合；对ELBWI的护理工作要精细；积极防治各种并发症。在治疗过程中努力争取患儿家人的理解与合作。出院后将ELBWI纳入高危儿管理系统是保证其生存质量的关健。

Objective To summarize experience from perinatal management of 12 extremely low birth weight infants（ELBWI）. Methods Clinical data from 12 extremely low birth weight infants inhospitalized in our hospital from Jan. 2001 to Apr. 2006 were analyzed retrospectively and the successful treatment experience was summarized. Results （1） Eight ELBWI were survival with survival rate 80% （8/12）. A ELBWI whose gestational age was 25 weeks and the birth weight was 650 g was successful survival. （2） Respiration failure, infection and internal milieu disorder were the most important threat that the ELBWI encountered after birth. （3） In this study, no complications sueh as retinopathy of prematurity, necrotizing enterocolitis, kernicterus occured. Conclusions The perinatal management of ELBWI is actually a systemic project, needing not only cooperation of the doctor and nurse,of both obstetrics and pediatrics, but also the ELBWI＇s legal guardian . In order to increase the survival rate and the quality of life, some complications such as bronchopulmonary dysplasia, intraventricular hemorrhage and periventrieular leukomalacia should be prevented and treated in time. At last, monitor and follow up the ELBWI＇s growth and development situation should be done after postcharge to improve the ELBWI＇s quality of life.