超低出生体重儿43例临床分析

Clinical analysis of 43 extremely low birth weight infants

目的分析我院五年内收治超低出生体重儿(ELBWI)的并发症、死亡原因及相关围产期高危因素。方法采用回顾性分析的方法,对2008年1月至2012年12月我院出生的ELBWI的临床资料进行分析。结果五年期间我院共分娩36 991名活产新生儿,出生ELBWI 47例,出生率0.13%;其中4例出生后即转院治疗,故43例纳入研究,胎龄(27.8±2.6)周,出生体重(853±108)g。43例ELBWI中,早期存活并进行救治27例,其中并发新生儿呼吸窘迫综合征20例,发生率74.1%(20/27);并发支气管肺发育不良7例,发生率25.9%(7/27)。43例ELBWI中存活至出院13例,总存活率30.2%(13/43);30例死亡,其中21例放弃治疗死亡,9例死亡原因分别为呼吸窘迫综合征、重症感染各3例,坏死性小肠结肠炎2例,肺出血1例。死亡婴儿生后1 min Apgar评分及5 min Apgar评分均低于存活者(P<0.05)。结论医患同盟积极救治ELBWI,减少出生窒息,积极处理各种并发症,可提高ELBWI存活率及生存质量。

Objective To analyze survival,complications,and perinatal risk factors of extremely low birth weight infants （ELBWI）.Methods Retrospective analysis was conducted using clinical data of ELBWI admitted in our hospital between January 2008 and December 2012.Results Among the 36 991 infants delivered in our hospital over the five years of study period,47 were ELBWI with incidence of 0.13%.Four ELBWI infants were transferred to other hospitals,therefore,were excluded from the study.Of the 43 ELBWI cases recruited,gestational age at birth was （27.8 ± 2.6）wks,birth weight was （853 ± 108） g.Among the 27 ELBWI survived early resuscitation and treatment period,74.1% had respiratory distress syndrome （20/27）,25.9% had bronchopulmonary dysplasia （7/27） and 13 infants survived to hospital discharge; this represents a survival rate of 30.2% （13/43）.Among the 30 ELBWI deceased,causes that led to mortality were abandon of treatment （21 cases）,RDS （3 cases）,severe infection （3 cases）,NEC （2 cases）,and pulmonary hemorrhage （1 case）.1 and 5 minute Apgar scores of infants deceased were lower than those who survived （3.6 ± 2.5 vs.5.4 ± 2.3,6.4 ± 1.9 vs.7.5 ± 1.2,P 〈 0.05）.Conclusions Physician-Parent alliance takes active roles in treatment of ELBWI,reduce birth asphyxia,and management of various complications.This alliance may thus improve the survival rate and quality of life in ELBWI.