住院不足24h放弃治疗出院新生儿相关因素分析

The correlation factor analysis of the neonates abandoned in hospital less than 24 hours

目的 探讨我院住院不足24 h放弃治疗出院新生儿的相关因素,提高本地区新生儿救治技术和人口生存质量.方法 对2007年至2011年住院不足24h的379例新生儿的临床资料进行回顾性分析,对24 h内放弃治疗出院的122例新生儿及住院大于24 h的244例新生儿的相关因素进行单因素及多因素回归分析.结果 （1） 2007年至2011年住院不足24h新生儿共379例,放弃治疗组122例.放弃、转院、好转和未愈四组的胎龄和体重比较差异均有统计学意义（P＜0.01）.（2） 2007年至2011年住院不足24h放弃治疗出院新生儿呈逐年下降趋势（卡方趋势检验x2=6.115,P=0.013）,未愈组呈逐年上升趋势（P＜0.05）,转院组与好转组无逐年上升或下降趋势（P＞0.05）.（3） 24 h内放弃治疗组与住院大于24h组比较,在胎龄、出生体重、剖宫产、产时窒息、宫内窘迫、出生医院、家庭年收入＜2万元、父亲文化程度高中及以下、诊断早产儿、极低体重儿、低体重儿、呼吸窘迫综合征、脑损伤等方面差异有统计学意义（P＜0.05）.男性、产时高危因素、母亲疾病状态、母亲既往流产史差异无统计学意义（P＞0.05）.（4）剖宫产、宫内窘迫、出生于县级医院及以下级别医院、家庭年收入＜2万元、诊断为呼吸窘迫综合征,与24h内放弃治疗出院有相关性,且均为危险因素.其他因素与24h放弃治疗出院无相关性.结论 建立系统的产检制度,尽量避免早产,减少呼吸窘迫综合征的发生.增加新生儿科的硬件配置及医护人员的配置,提高专业技术水平,完善社会保障机制,减少住院不足24 h放弃治疗出院新生儿,提高本地区新生儿救治技术和人口生存质量.

Objective To investigate the relative factors of the neonates that were abandoned in hospital less than 24 hours,then the level of the local neonates medical service and the neonatal remedy skills and the life quality could be improved.Methods The clinical data of 379 cases of hospitalized neonates less than 24 hours from 2007 to 2011 were analyzed retrospectively.The correlation factors of the neonates abandoned in hospital less than 24 hours（122 cases） and hospitalized more than 24 hours （244 cases） were analyzed by single and multiple factor regression analysis.Results （1） There were 379 neonates who were in hospital less than 24 hours,among them,122 neonates were gave up the treatments.The differences of the gestational age and weight among abandon group,hospital referral group,improve group and uncured group were significant（P ＜0.01）.（2） The numbers of neonates abandoned in hospital less than 24 hours were different significantly from 2007 to 2011 （P ＜0.05） and tendency was decreased year by year（chi-square trend test x2 =6.115,P =0.013）.The uncured group was increased year by year （P ＜ 0.05）.The hospital referral group,improved group were fluctuation,but no descend or rise tendency（P ＞0.05）.（3） The differences of the gestational age,birth weight,uterine-incision delivery,intrapartum asphyxia,intrauterine distress,birth hospital,family income less than twenty thousand yuan every year,father＇s culture level,diagnosed premature,very low birth weight infant,low birth weight infant,respiratory distress syndrome and brain injuries were significant between neonates in hospital less than 24 hours and more than 24 hours（P ＜ 0.05）.The differences of the male,intrapartum high risk factors,mother＇s morbid state and miscarriage were not significant（P ＞0.05）.（4） The uterine-incision delivery,intrapartum asphyxia,birth in the county and below county hospital,family income less than twenty thousand yuan every year and diagnosed respiratory distress syndrome were correlation to the abandon treatment in 24 hours.There were no correlation to the gave up treatment in 24 hours to the rest of the factors.Conclusion We should set up the systemic gravid detection system,avoid premature birth and respiratory distress syndrome,add the hardware configuration and medical personnel to the neonate department,improve the professional technology level,perfect social security system mechanism,decrease the hospital discharge rate of the hospitalization less than 24 hours,improve the level of the local neonatal treatment technology and the quality of population.