重度新生儿窒息58例临床分析

Clinical analysis on 58 neonates with severe asphyxia neonatorum

目的：探讨预防新生儿窒息的措施,以降低新生儿窒息的发生率。方法：收集该院2006-2008年58例重度新生儿窒息有关临床资料,分析发病的相关高危因素,探讨有效的降低新生儿窒息发生率的预防措施。结果：2006年1月-2008年12月新生儿窒息发生率为4.11%,其中重度新生儿窒息发生率为1.70%,矫正死亡率为6.90%。重度窒息的相关因素前7位依次为：胎儿宫内窘迫（47.44%）、早产（48.28%）、脐带因素———缠绕、脱垂及过短（36.21%）、臀位（27.59%）、重度妊娠期高血压疾病（18.97%）、畸形（8.62%）、胎盘早剥及前置胎盘（8.62%）,该组产妇大多数无业,约2/3没有做过产检;有15例在家非法接生不成功后住院。结论：加大孕产妇分级管理的力度,加强孕期保健和产检,及早发现和治疗妊娠期高血压疾病,适时纠正臀位,尽量减少早产,及早发现和正确处理胎儿宫内窘迫,及早发现和处理畸形儿,制止非法接生,是降低新生儿重度窒息的有效措施,并建议重视脐带因素,放宽其剖宫产的指征。

Objective： To explore the preventive measures of asphyxia neonatorum in order to reduce the incidence of asphyxia neonatorum. Methods ： Clinical data of 58 neonates with severe asphyxia neonatorum from 2006 to 2008 were collected, high risk factors of asphyxia neonatorum were analyzed, effective preventive measures were studied. Results： The incidence of asphyxia neonatorum from January 2003 to December 2004 was 4. 11% , 1.70% of which were severe asphyxia neonatorum, the mortality was 6. 90%. The related factors of severe asphyxia neonatorum were listed as follows from high to low： fetal distress （47. 44% ）, premature delivery （48. 28% ）, umbilieal factors -torsion, prolapse and shortening （36. 21% ） , breech presentation （27.59%）, severe hypertensive disorder complicating pregnancy （ 18.97% ）, monstrosity （ 8.62% ）, placental abruption and placenta praevia （8. 62% ） . Most of the pregnant women were out of work and about two thirds had no antenatal care. 15 cases came to hospital because of no effect of illegal accouchement at home. Conclusion： Effective measures of reducing severe asphyxia neonatorum should be taken, such as to strengthen the monitoring of pregnant women and their antenatal care, to lind and treat hypertensive disorder complicating pregnancy early and correct breech presentation in time, to try to reduce premature delivery, to find early and properly treatment of fetal distress and oafs and to prohibit illegal accouchement. Meanwhile, paying attention to umbilical factors and broadening cesarean section indication are also suggested.