影响极低出生体重儿近期预后疾病及其析因分析

Diseases associated with the short-term outcome of very low birth weight infant and study of the causes

目的探讨极低出生体重儿(VLBW)近期预后的疾病及其危险因素和保护因素。方法总结重庆医科大学附属儿童医院2001年6月至2010年2月收治的475例符合纳入标准的VLBW患儿临床资料,找出对近期预后有显著影响的疾病。对这些疾病行单因素分析,将单因素分析中差异有统计学意义的变量代入logistic回归模型分析。结果近期预后良好339例(71.37%);近期预后不良136例(28.62%),两组中差异有统计学意义的疾病是新生儿呼吸窘迫综合征(NRDS)[11.8%(40例)vs38.2%(52例),χ2=43.434,P=0.000]、肺出血[2.9%(10例)vs25.0%(34例),χ2=56.147,P=0.000]。NRDS的危险因素为低出生体重(OR=6.368,P=0.000)、小于胎龄儿(OR=5.806,P=0.000)、有窒息史(OR=2.087,P=0.006)、产前未用地塞米松(OR=1.948,P=0.014);NRDS的保护因素为胎膜早破(OR=0.419,P=0.004)。肺出血的危险因素为NRDS(OR=10.473,P=0.002)、硬肿(OR=2.265,P=0.027);肺出血的保护因素为胎膜早破(OR=0.167,P=0.013)。结论 NRDS、肺出血是影响VLBW近期预后的重要疾病。

Objective To investigate the causes of diseases associated with the short-term outcome of very low birthweight （VLBW） infant and their risk and protective factors. Methods Review the critical diseases which can affect the short-term outcome of the total 475 cases in the Neonatology Department of Children＇s Hospital of Chongqing Medical University from June 2001 to February 2010. Variables associated with these diseases were identified firstly with univariate analysis and then with a forward stepwise logistic regression. Results The number of VLBW with favorable and poor short-term outcome was 339 （71.37%） and 136 （28.62%） respectively, and the following diseases were associated with the short-term outcome of VLBW： neonatal respiratory distress syndrome （NRDS）[ 11.8% （n = 40 ）vs 38.2% （n = 52 ）, X^2 = 43.434,P = 0.000] and pulmonary hemorrhage （PH） [2.9%（n = 10） vs 25%（n = 34）, X^2 = 56.147,P = 0.000].The risk factors for development of NRDS were low birth weight （OR = 6.368, P = 0.000） , being small for gestational age （SGA） （OR = 5.806, P = 0.000）, history of asphyxia （OR = 2.087, P = 0.006） and antepartum non-dexamethasone-treated （OR = 1.948, P = 0.014） .The protecting factor was history of premature rupture of membrane （PROM） （OR = 0.419, P = 0.004）.The risk factors for development of PH were NRDS （OR = 10.473, P = 0.002） and scleroma neonatorum（OR = 2.265,P = 0.027） ;the protecting factor was PROM（OR = 0.167,P = 0.013）. Conclusion Important diseases that can affect short-term outcome of VLBW are NRDS and PH.