早产儿转运安全性分析

Security in Premature Infant Transportation

目的 探讨早产儿转运安全性及预后的影响因素.方法 对2010年1月至2012年12月由清华大学第一附属医院出车转回NICU的早产儿333例,根据新生儿危重病例评分法将333例早产儿分为＞90分（n=266）、70～90分（n=63）及＜70分（n=4）3组,分析评分分值与胎龄、有创机械通气和住院时间的关系;预防使用肺表面活性物质与有创机械通气的关系.结果 转运早产儿中主要疾病顺序为新生儿肺炎,早产儿、低出生体质量儿,新生儿呼吸窘迫综合征,新生儿高胆红素血症,新生儿低血糖,新生儿缺氧缺血性脑病及先天性心脏病.新生儿危重度评分分值越低,则胎龄越低、有创机械通气率越高、住院时间越长（均P＜0.01）;转运前预防使用肺表面活性物质的早产儿行有创机械通气率均明显低于未预防使用的早产儿（15.8％比34.5％,P＜0.05）.结论 新生儿危重病例评分法能反映早产儿病情危重程度,可指导治疗和提高转运过程中的安全性;转运前预防使用肺表面活性物质可以减少早产儿有创机械通气率.

Objective To investigate the factors affecting the security and prognosis of premature infant transportation, Methods According to neonatal critical degree （SNCD）scores, 333 premature infants who were transported to NICU of Tisnghua University first affiliated hospital by automobile from Jan 2010 to Dec 2012 were divided into three groups：〉90 （n=266）,70-90 （n=63）and 〈70 （n=4）.The relationships of SNCD scores to gestational age, invasive mechanical ventilation and hospitalization time and the relationships of pulmonary surfactant therapy to invasive mechanical ventilation were analyzed. Results The rank order of major diseases in the transported newborns was dominated by neonatal pneumonia, low birth weight, neonatal respiratory distress syndrome, neonatal hyperbilirubinemia, neonatal hypoglycemia, neonatal hypoxic-ischemic encephalopathy, and congenital heart disease. With the reduction of SNCD scores, gestational age decreased and invasive mechanical ventilation rate and hospital stay increased in premature infants （P〈0.01）. In addition, the invasive mechanical ventilation rate in infants who received pulmonary surfactant before transportation was significantly lower than that in infants who did not receive pulmonary surfactant （15.8% vs 34.5% ,P〈0.05）. Conclusion SNCD scoring can reflect the severity of illness, guide the treatment and improve the security during transportation in premature reduce invasive mechanical infants. Preventive use of pulmonary surfactant before transportation can ventilation rate in premature infants.