新生儿休克死亡相关因素分析

Clinical study on death-related factors of neonatal shock

目的分析影响新生儿休克死亡的相关因素。方法回顾性分析中国医科大学附属盛京医院新生儿病房2007年1月至2009年4月收治的50例休克新生儿临床资料。比较存活与死亡患儿的临床特点并进行单因素χ2检验和多因素Logistic回归分析。结果存活26例,死亡24例,病死率48.0%。50例中,足月儿36例,死亡14例,病死率38.9%;早产儿14例,死亡10例,病死率71.4%。休克类型以感染性休克为主,共29例(占58.0%),其中早产儿感染性休克9例,占早产儿休克64.3%;败血症为其主要基础疾病。休克合并器官功能衰竭42例,其中合并肺功能衰竭31例,占首位(73.8%)。χ2检验单因素分析结果显示,胎龄、入院体重、日龄、5分钟Apgar评分、pH值、血压、器官功能衰竭对新生儿休克死亡有显著影响(P均<0.05);多因素Logistic回归分析共筛选出3个影响因素,分别是胎龄(OR=0.006,95%CI0.000-0.583,P=0.028)、血压(OR=0.025,95%CI0.002-0.297,P=0.004)、多器官功能衰竭(OR=14.949,95%CI1.181-189.250,P=0.037)。结论新生儿休克所致的死亡与胎龄、血压、多器官功能衰竭显著相关。

Objective To analyze variables associated with death of neonatal shock and to determine the death-related factors. Methods The clinical data of fifty cases of neonatal shock in NICU of Shengjing Hospital affiliated to China Medical University from January 2007 to April 2009 were retrospectively analyzed. Compare the clinical characteristics of the survivors and the dead children. Both univariate analysis and multivariate Logistic regression analysis were used to find out the variables associated with death and death-related factors. Results Twenty-six infants survived and 24 died ; the overall death rate of the neonatal shock was 48.0%. Fourteen of 36 term neonates died （ the death rate 38.9%） while 10 of 14 preterm neonates died （ the death rate 71.4% ） ; 29 cases were septic shock （58.0%）. Septic shock in these shock patients made up the most proportion. Nine among 14 （64.3%） preterm infants in the research had septic shock. Septicemia was found to be main primary disease of septic shock. Forty-two shock patients had failure of organ function, among which failure of respiratory function took the first place （73.8%）. Univariate analysis showed that gestational age, weight at onset of shock, dates after birth, Apgar score at 5mins, pH, blood pressure and multiple organ failure were associated with death of neonatal shock （P 〈 0.05）. Multivariate Logistic regression analysis showed that there were three significant predictors： gestational age （odds ratio 0.006, 95% confidence interval 0.000-0.583, P = 0.028） , blood pressure （odds ratio 0.025, 95% confidence interval 0.002-0.297, P = 0.004） and multiple organ failure （odds ratio 14.949, 95% confidence interval 1.181-189.250, P = 0.037）. Conclusion Gestational age, blood pressure and multiple organ failure are related to the death of neonatal shock.