极低出生体重儿入室低体温的影响因素分析

Analysis of influencing factors of admission hypothermia in very low birth weight infants

目的 探讨极低出生体重儿（VLBWI）入室低体温的影响因素,为临床护理提供依据.方法 回顾性分析2009年1月至2011年4月在温州医学院附属第二医院产科出生,胎龄小于32周,出生后即转往NICU救治的287例VLBWI的病历资料,根据入室体温分为低体温组（体温＜36℃）181例和对照组（体温≥36℃）106例,观察两组VLBWI及产妇相关临床资料和出生时的产房温度、入室时间等指标.结果 胎儿入室体温低于36℃的发生率为63.07％.两组VLBWI母亲的分娩前体温、产前使用糖皮质激素、分娩方式和VLBWI出生体重、1 rin、5 rin Apgar评分气管插管情况、入室时间、产房温度比较差异均有统计学意义（Z/x2值分别为6.29,10.65,8.87,5.85,20.42,12.99,18.22,14.11,9.04;P＜0.05）,而母亲的年龄、孕次、产次、多胎、胎膜早破的发生率、VLBWI的胎龄、性别等比较,差异无统计学意义（P＞0.05）.多因素Logistic回归分析发现,产前未使用激素、剖宫产、1 min Apgar评分低、产房温度低、入室时间长是导致VLBWI入室低体温的主要危险因素.结论 VLBWI入室低体温的影响因素较多,主要与产前使用激素、分娩方式、1 min Apgar评分、产房温度和入室时间有关.

Objective To discuss the influencing factors of admission hypothermia in very low birth weight infants （VLBWI）,so as to provide references for clinical nursing during delivery.Methods 287 cases of VLBWI from January 2009 to April 2011 who were less than 32 weeks and transferred to NICU after birth were studied by retrospective analysis and divided into the hypothermia group （body temperature ＜ 36 ℃） with 181 cases and the control group （body temperature ≥ 36 ℃） with 106 cases according to their admission body temperature.Clinical records of VLBWI and parturient,temperature of the delivery room at birth and admission time were observed and compared between two groups.Results The incidence rate of infants whose admission body temperature was lower than 36 ℃ was 63.07％.Mother＇s pre-delivery body temperature,antenatal glucocorticoid,delivery mode as well as birth weight,1 min and 5 min Apgar score,status of trachea cannula and time of entering ward of VLBWI and room temperature were significantly different between two groups （Z/x2 =6.29,10.65,8.87,5.85,20.42,12.99,18.22,14.11,9.04,respectively; P ＜ 0.05）.However,mother＇s age,gravidity,parity,multipara,the incidence of premature rupture of membrane as well as gestational age and gander of VLBWI were found no significantly different between two groups （P ＞ 0.05）.Multivariate logistic regression analysis showed that no prenatal hormone,cesarean section,low Apgar score on the 1st min,low temperature in the delivery room and long admission time were the main influencing factors of admission hypothermia in very low birth weight infants.Conclusions Admission hypothermia in very low birth weight infants was mainly associated with prenatal use of hormones,cesarean section,Apgar score on the 1 st min,temperature of the delivery room and admission time.