极低出生体重儿转归因素分析及肺表面活性剂的作用

Constitution of the Complications of Very Low Birth Weight Infants and Analysis of Factors Related to the Outcome

目的:探讨影响极低出生体重儿(VLBWI)转归的相关因素及肺表面活性剂(PS)在其中的作用。方法:将305例VLBWI分别按出生体重和住院年份分组,对其临床资料进行回顾性分析。结果:所有住院患儿均有一种及以上的并发症,最常见的为病理性黄疸(53.4%)、酸中毒(43.3%)、呼吸暂停(33.3%)、新生儿硬肿症(32.1%)。本组总体院内病死率为3.0%,其中出生体重≤1000g组、～1250g组及～1500g组分别为12.0%、3.3%和1.6%,组间比较差异有统计学意义(P<0.05)。前三年后四年两个时间段比较,病死率差异无统计学意义(P>0.05)。导致VLBWI死亡的主要原因为新生儿呼吸窘迫综合征(66.6%);使用PS组治疗NRDS治愈率显著高于未使用PS组(61.5%比21.7%,P<0.05)。结论:体重、严重新生儿并发症是影响VLBWI转归的重要因素;NRDS是致VLBWI死亡的最主要原因;应用PS可以明显提高临床NRDS的治愈率。

Objective：To investigate the constitution of the complications and the factors in relation to improving outcome of very low birth weight infants （VLBWI）. Methods ： The clinic data of 305 VLBWI during the past 8 years was analyzed retrospectively by dividing patients into three groups according to the birth weight, and into two groups according to the admitting chronology. Results ： All hospitalized VLBWI had at least one complication, and the most common were pathologic jaundice （ 163 cases, 53.4% ）, acidosis （ 132 cases, 43.3% ）,apnea （101 cases, 33.3% ） and sclerema neonatorum （98 cases, 32.1% ）. The total cure rate, abandon rate and hospital mortality were respectively 89.5%, 7.5% and 3.0%. The difference of the aforesaid three index among different birth weight groups （ birth weight ≤ 1,000 g, - 1,250 g and -1,500 g） was significant（X^2 = 27. 819, 13. 763 and 6.571, P 〈 0.05）. The difference of total cure rate and hospital mortality between the former 3 years and the latter 4 years was not apparent （X^2 = 2. 304 and 1. 409, P 〉 0.05 ）. Neonatal respiratory distress syndrome （NRDS） was the primary cause of the death （66.6%）. The cure rate of NRDS in the pulmonary surfactant （PS） therapy group was significantly higher than that in the no PS therapy group （ 61. 5% vs 21. 3%, P 〈 0. 05 ）. Conclusions： The birth weight and severe neonatal complications are the important factors related to the outcome of VLBWI. Neonatal respiratory distress syndrome is the primary cause of VLBWI death. The clinic application of PS could improve the cure rate of NRDS.