早发型重度子痫前期早产婴儿存活影响因素分析

Study on factors affected survival rate of neonatal and infant in early-onset severe pre-eclampsia with conservative management

目的探讨早发型重度子痫前期早产儿婴儿期存活的影响因素。方法对比分析2001年1月至2006年5月在北京大学第三医院分娩的孕周〈34周的早发型重度子痫前期活产早产儿与随机抽取的同时期孕周匹配的自发性早产活产早产儿婴儿期结局,并进行多因素分析。结果研究组活产新生儿86例,随访71例（82.6%）;对照组活产新生儿114例,随访96例（84.2%）。研究组婴儿期死亡15例（21.1%）,其中早期新生儿期死亡12例（16.9%）;对照组婴儿期死亡10例（10.4%）,早期新生儿期死亡5例（5.2%）。研究组早期新生儿期死亡率明显高于对照组（P=0.014）,两组间婴儿期死亡率差异无统计学意义（P〉0.05）。多因素分析显示,是否入住NICU实施积极救治是影响早产儿婴儿期死亡率的主要因素（OR 0.016,95%CI 0.002-0.113）。当去除NICU因素,孕龄和有无新生儿窒息是影响早发型重度子痫前期早产儿婴儿期死亡率的主要因素（OR 0.516,95%CI 0.296-0.902;OR 5.363,95%CI 1.703-16.891）。结论早发型重度子痫前期是早产儿早期新生儿期死亡的影响因素,孕龄和新生儿窒息是影响早发型重度子痫前期婴儿期生存率的主要因素。家属救治态度以及NICU在改善高危儿预后方面有重要影响。重度子痫前期作为独立因素不增加34孕周前早产儿的婴儿期不良结局风险,对早发型重度子痫前期患者进行保守治疗可以改善婴儿预后,降低婴儿丢失率,家属救治意愿是不可忽视的因素。

Objective To investigate influential factors in the prognosis of neonatal and infant born of early-onset severe pre-eclampsia with conservative treatment.Methods All the live-birth preterm infants,less than 34 weeks gestational age,delivered by women with early-onset severe pre-eclampsia in Peking University Third Hospital from Jan 2001 to May 2006,were recruited in this study.Spontaneous early preterm live-birth infants during the same period were as control,matched by gestational age.Contrastive analysis was conducted on neonatal mortality and infant mortality.Nonparametric tests and Logistic regression were used.Results The study group included 86 cases,and 71（82.6%） were followed up.The control group had 114 cases,and 96（84.2%） were followed up.The early neonatal death rate was higher in the study group than the control,16.9% vs.5.2%（P=0.014）.No significant difference was detected between the two groups on infancy mortality,late neonatal mortality and post-neonatal mortality（all P〉0.05）.Logistic regression analysis showed that willingness of family and NICU medical supports were the largest factors affect the infancy mortality（OR 0.016,95% CI 0.002-0.113）.Analysis in the group of NICU admission cases showed that gestational age（OR 0.516,95% CI 0.296～0.902） and neonatal asphyxia（OR 5.363,95% CI 1.703～16.891） affected the infancy mortality in early-onset severe pre-eclampsia significantly.Conclusions Early-onset severe pre-eclampsia is a main cause of early neonatal death in preterm infants.Gestational age and neonatal asphyxia affect infancy survival rate.As an independent factor,early-onset severe pre-eclampsia do not raise infancy mortality in preterm infant whose gestational age is less than 34 weeks.Willingness of family and NICU medical supports,as well as conservative treatment of pre-eclampsia,play crucialroles in improving outcomes of high-risk infants and decreasing infant lose.