晚期早产儿低氧性呼吸衰竭的病死率及其影响因素分析

Mortality and the related factors of hypoxemic respiratory failure in late preterm infants

目的 探讨山东省中东部地区晚期早产儿低氧性呼吸衰竭病例的分布情况及其病死率的的影响因素,为提高晚期早产儿呼吸衰竭临床诊治水平提供理论依据,为今后山东全省乃至全国的相关研究提供参考依据.方法 采用整群抽样的原则选取山东省中东部地区7所医院内NICU自2010年1月1日至2012年12月31日收治的,诊断为呼吸衰竭的晚期早产儿216例.分析患儿的基本资料、原发疾病、临床诊疗方法、结局、病死率及影响因素.结果 （1）共收回调查问卷216份,男女比例为1.3∶1,发生呼吸衰竭的病因各地区不尽相同.（2）平均出生体重为（2660＆#177;686）g,最小体重1 900 g,最大体重3 600 g.合并先天畸形38例,其中6例合并2种以上畸形.先天畸形中,先天性心脏病（包括动脉导管未闭）16例.孕母年龄最小18岁,最大42岁,平均32岁;分娩方式中经阴顺产和剖宫产例数相当,分别为110例和106例.孕母产前应用糖皮质激素促进胎肺成熟137例.（3）患儿主要原发疾病为呼吸窘迫综合征112例、肺部感染和败血症52例.常见并发症主要为肺部感染、败血症23例,动脉导管未闭89例,重要脏器出血7例.（4）不同胎龄呼吸衰竭晚期早产儿病死率总体上差异有统计学意义（χ2 =157.148,P=0.000）,胎龄越小,病死率越高.（5）影响病死率的因素中,合并先天畸形[OR=2.063,95％CI （1.297,3.264）]、低出生体重[OR=4.335,95％CI（1.636,11.497）]、重要脏器出血[OR =4.598,95％ CI（1.370,14.925）]、单用常频机械通气[OR =0.531,95％CI（0.314,0.902）]的呼吸衰竭晚期早产儿死亡风险高.结论 目前山东省中东部地区因各种疾病导致的呼吸衰竭发生率较低,原发疾病主要为呼吸窘迫综合征、肺部感染和重度室息.晚期早产儿呼吸衰竭治疗时间更长,多种治疗手段的应用显著改善患儿预后.

Objective To discuss the case distribution and the influencing factors of mortality of late preterm infants with hypoxemic respiratory failure in middle and east of Shandong province.And to provide a theoretical basis for the improvement of the level of clinical diagnosis and treatment in late preterm infants with respiratory failure and provide reference evidence for the related researches in Shandong province and even the whole country.Methods Two hundred and sixteen late preterm infants with respiratory failure were selected as the study objects to carry out prospective trial by cluster sampling from 7 hospitals of the middle and east of Shandong province from Jan 1,2010 to Dec 31,2012.The basic information,primary disease,clinical diagnosis and treatment methods,clinical outcome,mortality and influencing factors were analyzed.Results （l） All 216 investigation questionnaires were received.The ratio of male to female was 1.3∶ 1.The pathogenesis that leaded to the incidence of respiratory diseases were not identical in various places.（2） Mean birth weight was （2 660 ＆#177; 686） g,the minimum birth weight was 1 900 g and the maximum birth weight was 3 600 g.There were 38 cases with congenital anomalies,including 6 cases with 2 or more kinds of malformation,and congenital heart disease （including patent ductus arteriosus） was 16 cases.Mean age of mothers with respiratory failure infants was 32 years,the minimum one was 18 years and the maximum one was 42 years.The overall cesarean section rate was same to the one of spontaneous labor（106 cases vs 110 cases）.One hundred and thirty-seven cases with acute respiratory failure received antenatal steroids.（3） The main primary diseases of infants with respiratory failure were respiratory distress syndrome（112 cases）,pulmonary infection and sepsis （52 cases）.The complications were,in turn,pulmonary infection and sepsis （23 cases）,patent ductus arteriosus （89 cases） and vital organs hemorrhage （7 cases）.（4） The case fatality rate of infants within 34 to 35 weeks and 35 to 36 weeks were 10.2% and 8.7% respectively,which were significantly higher than those of infants within 36 to 37 weeks （x2 =157.148,P =0.000）.（5） Congenital malformation [OR =2.063,95 % CI （1.297,3.264）],low birth weight [OR =4.335,95 % CI （1.636,1 1.497）],vital organs hemorrhage [OR =4.598,95 % CI（1.370,14.925）] and mechanical ventilation alone [OR =0.531,95 % CI（0.314,0.902）] linked to higher risk of death after respiratory failure for the late preterm infants.Conclusion At present,respiratory failure caused by various diseases occurred at low frequencies in the middle and east of Shandong province.The primary diseases are respiratory distress syndrome,pulmonary infection,and severe asphyxia.It takes more time to treat the late preterm infants with respiratory distress and the prognosis can be improved by a variety of treatments.