围生期高危儿系统管理12年回顾分析

A 12-year research of systemic management for perinatal high-risk infant

目的总结我院逐步建立的围生期高危儿系统管理模式的效果。方法回顾性调查实施围生期高危儿系统管理模式前后,在我院出生的新生儿及其相关资料,分析高危儿管理后生活质量的主要指标,如围生期死亡率、窒息发生率、极低出生体质量儿发生率、死亡率和超低出生体质量儿合并症、发生中枢协调障碍的围产因素、干预效果等。结果围生期高危儿管理系统建立前后对比显示,尽管分娩数逐年增加,但围生儿死亡率呈明显下降趋势,窒息率明显下降(P=0.000);极低和超低出生体质量儿存活率不断提高;发生中枢协调障碍的各种高危因素。依次胎儿宫内窘迫(30.5%)、母亲早期感染史(28.5%)、母亲妊娠糖尿病者(27.8%)、足月小样儿(26.7%)、早产儿(25.8%)、新生儿窒息(25.0%)、新生儿缺血缺氧性脑病(23.1%)、妊娠早期阴道流血史(20.5%)、新生儿高胆红素血症(15.9%)等;实施系统管理高危儿较门诊对照组中中枢协调障碍患儿发现早、疗程短、疗效好。结论围生高危儿系统管理模式的建立,确实能有效提高围生高危儿的生活质量,降低死亡率和伤残率。

Objective To study the effectiveness of perinatal high-risk infant systemic management which was established gradually in our hospital. Methods The data of all of the neonates horned in our hospital were investigated retrospectively before and after the establishment of systemic management model of perinatal high-risk infant. The main index that reflected the quality of high-risk infants life after the systemic management were ananalysed such as perinatal mortality rate, incidence of asphyxia, incidence and survival rate of very low birth weight infant, the complication of extremely low birth weight infants, perinatal factors and intervention effectiveness of central coordination disorder. Results Comparision before and after the establishment of management system of perinatal high-risk infant showed that the perinatal mortality rate and asphyxia rate decreased obviously as the number of delivery increased year by year. The survival rate of very low birth weight infant and extremely low birth weight infants increased gradually （ P = 0. 000 ） ; The high risk factors of central coordination disorder were fetal distress （30. 5% ）, mother of the history of early infection （28. 5% ）, gestational diabetes mothers （27.8%）, small for gestational age full term infants （26. 7% ）, premature infants （25. 8% ）, neonatal asphyxia （25. 0% ）, neonatal hypoxic-ischemaic encephalopathy （23.1%）, history of vaginal bleeding during early pregnancy （20. 5% ）, hyperbilirubinemia （ 15.9% ） ; high-risk infants in systemic management were found with central coordination disorder earlier and had better therapy effectiveness, shorter period of therapy than that of the control group in outpatient clinic. Conclusion The establishment of systemic management model for perinatal high-risk infant can improve the quality of life, decrease mortality rate and disability rate effectively of highrisk infant.