近足月新生儿窒息复苏后的近期预后

The prognosis of near full-term neonatal asphyxia and resuscitation

目的对窒息新生儿复苏后的临床表现,进行回顾性分析,比较足月儿与近足月儿(34周≤胎龄<37周)窒息复苏后在新生儿早期的预后。方法研究对象为2002年8月至2006年3月复旦大学妇产科医院新生儿科收治的窒息后足月儿263例和近足月儿83例,有先天性畸形的患儿被排除。收集资料(包括母亲的孕期并发症、羊水情况、分娩方式,新生儿出生体重、Apgar评分等),比较近足月儿和足月儿呼吸困难及近期预后不良(因病重转院、放弃治疗或死亡)的发生情况。结果足月儿组出现呼吸困难表现的为39.9%(105/263),因病重转院、放弃或死亡的为6.1%(16/263),平均吸氧时间为2d/(1～4)d,平均住院时间为4d/(2～8)d。近足月儿组出现呼吸困难的为57.8%(48/83),较足月儿组高(P<0.01);新生儿早期预后不良为30.1%(25/83),高于足月儿组(P<0.001),平均吸氧时间为2.5d/(1～6)d,平均住院时间为9d/(1～24)d,均高于足月儿组(P<0.001,P<0.001)。近足月儿中,经剖宫产娩出的新生儿呼吸困难发生率高于经阴道分娩的新生儿(P<0.01)。结论近足月儿窒息复苏后,呼吸困难和新生儿早期预后不良发生率高于足月儿组。因此,临床上需对近足月儿窒息复苏后的处理加以重视。

Objective To retrospectively analyze the clinical manifestations of resuscitation of neonatal asphyxia, and compare the prognosis of neonatal asphyxia between full-term infants and near full- term infants （34 weeks≤gestational age 〈37 weeks）. Methods 263 cases of the full-term neonatal asphyxia （the full-term infants group） and 83 cases of the near full-term neonatal asphyxia （the near full- term infants group）, were enrolled in this study. Children with congenital abnormality were excluded. Collect information including mothers＇ pregnancy complications, amniotic fluid situation, mode of delivery, birth weight and Apgar score, compare the respiratory difficulties and the occurrence of poor prognosis between near full-term infants and full-term. Results In the full-term infants group, 39.9 had dyspnea and 6. 1% had poor prognosis. Among 83 cases （the near full-term infants group）, the incidence of dyspnea and poor prognosis was 57.8 % and 30.1%, respectively. The difference between the term infants and the near term infants was significant （P〈0.01）. Among the near full-term infants, the dyspnea occurrence rate of cesarean section was higher than vaginal delivery. Conclusion The full-term infants recovered quickly from birth asphyxia resuscitation and had a good prognosis. However, in the near term infants, the incidence of dyspnea and poor prognosis were higher than those of the full-term infants. It suggests that the near term infants need more post-resuscitation care than the full-term infants.