极低出生体质量儿309例生存危险因素分析

Analysis of Risk Factors for Survival of 309 Very Low Birth Weight Infants

目的探讨极低出生体质量儿(VLBWI)出生的危险因素及影响其存活率的因素。方法对2002年1月-2007年12月收治的309例VLBWI按出生体质量分为≤1000g、1001～1250g、1251～1500g组,对其一般资料、临床转归及常见并发症等临床资料进行回顾性分析。结果治愈180例,治愈率58.30%,治愈率随体质量增加而上升(P=0.01);死亡16例,病死率5.20%,病死率随体质量增加而降低(P=0)。导致VLBWI的主要原因有多胎妊娠(33例,10.68%)、胎膜早破(87例,28.15%)、妊娠并发症(包括妊娠高血压综合征、胎盘早剥及前置胎盘)(66例,21.36%)、习惯性早产(13例,4.21%)、妊娠期母患内科慢性疾病(24例,7.77%)和原因不明(86例,27.83%)。住院VLBWI均有1种或1种以上并发症,主要有呼吸窘迫综合征(105例,33.98%)、肺炎(71例,22.97%)、脑室内出血(56例,18.12%)、呼吸暂停(50例,16.18%)、动脉导管开放(9例,2.90%)、败血症(6例,1.94%)。死亡的主要原因是肺出血、呼吸窘迫综合征、感染和脑室内出血。结论加强对VLBWI围生期高危因素的认识,积极预防早产,尽量延长孕周,采取综合治疗措施,避免并发症的发生,可降低其病死率,提高VLBWI的生存质量。

Objective To investigate the high risk factors for the survival of very low birth weight infants（VLBWI） and the relative factors for influencing survivability on VLBWI. Methods Three hundred and nine VLBWI hospitalized in our hospital from Jan. 2002 to Dec. 2007 were divided into 3 groups according to the weight,as：less than 1 000 group, 1 001 - 1 250 group, 1 251 - 1 500 group. Then the general clinical data, clinical prognosis, common complication of the cases were reviewed. Results There were 180 cases who had cured, the cure rate was 58.3%. The cure rate increased as the infant weight went up（P =0.01 ）. There were 16 infants dead,mortality was 5.17% ,which was Lower as the weight increased（ P = 0）. The risk factors causing the premature birth of VLBWI were related to the multiple births （33 cases, 10.68% ） , early amnion breaking（ 87 cases ,28.15% ） , pregnancy complications （including pregnancy induced hypertension syndrome （PIH） , placental abruption and placenta previa） （66 cases,21.36% ） , practice - premature （ 13 case ,4.21% ） , chronic illness in gestation （24 cases,7.77% ） and unclear reasons（86 cases,27. 83% ）. All hospitalized VLBWI had at least one complication including respiratory distress syndrome（ 105 cases, 33.98% ） , pneumonia （ 71 cases, 22.97% ） , intraventricular hemorrhage （ 56 cases, 18. 12% ） , apnea （ 50 cases, 16. 18% ） ,patent ductus arteriosus （9 cases,2. 90% ） , septemia （6 cases, 1.94% ）. The predominant causes of death were bleeding in the lungs, breath - embarrassment - synthesis, infection and encephalic bleeding. Conclusions It is important to strengthen the recognition of the high risk perinatal factors of the VLBWI, to prevent premature, to prolong its gestational age as far as possible, and to take combined therapy to avoid the complication in order to reduce mortality and improve its quality of life.