39例重度窒息足月新生儿围产期高危因素及复苏效果

Outcomes of resuscitation and perinatal risk factors of 39 dying full-term neonates suffered from severe asphyxia

目的了解足月重度窒息濒死儿（生后1minApgar评分0～1分）的围产期影响因素及复苏效果。方法深圳市妇幼保健院新生儿重症监护病房2003年1月至2014年6月共收治足月濒死儿39例，纳入研究。回顾性分析围产期的影响因素及复苏效果。采用x^2检验进行统计学分析。结果按患儿住院期间转归分为死亡组与非死亡组，死亡组娩出前无胎心的发生率高于非死亡组[2／7与0％（0／32），x^2=4．695，P=0．028]。39例濒死儿中死亡7例（死亡6例，放弃治疗死亡1例），病死率为18％（7／39）；存活32例，其中15例发生缺氧缺血性脑病（轻度和中度各7例、重度1例）。生后5min Apgar评分≤5分者共19例，病死率为7／19；另外12例存活，其中4例无神经系统并发症，8例发生缺氧缺血性脑病（轻度4例、中度3例、重度1例）。生后10min Apgar评分≤5分者共10例，放弃治疗或死亡7例，另3例存活，但均发生中度缺氧缺血性脑病。结论足月濒死儿经过有效复苏，大多预后良好，尤其是5min Apgar评分〉5分者。5min Apgar仍≤5分的患儿，应加强复苏后管理，以减少后遗症和并发症的发生。

Objective To investigate the prenatal or intrapartum risk factors, resuscitation and its outcomes among full-term but dying newborns after severe asphyxia （Apgar score was 0-1 at 1 rain after birth）. Methods Totally, 39 dying full-term newborns, who were admitted to the neonatal intensive care unit of Shenzhen Maternity＆Child Healthcare Hospital,Southern Medical University from January, 2003 to June, 2014 were analyzed retrospectively. Information on perinatal influencing factors and outcomes of resuscitation were collected and analyzed with Chi-square test. Results All of the babies were divided into died （n=7, 18%, one refused to further treatment） and survived group [n=32, among which 15 suffered from hypoxic-ischemic encephalopathy（HIE） （seven mild, seven moderate and one severe case）]. Fetal heart beat was undetectabie in more babies in the died group than in the survived group [2/7 vs 0%（0/32）, Z2=4.695, P=0.028]. There were 19 infants with Apgar score ≤ 5 at 5 rain,and seven of them died （7/19）. The other 12 survived with HIE occurred in eight cases （four mild, three moderate and one severe case） and the rest four babies did not report any neurological complications. Among the ten infants with Apgar score ≤ 5 at 10 min, seven died or refused to treatment and the other three survived with moderate HIE. Conclusions Most of the dying term babies may have promising outcomes after effective resuscitation, especially for those with Apgar score over 5 at 5 min. However, for those dying term babies with Apgar score remains≤ 5 at 5 rain, management after resuscitation should be strengthened to reduce the occurrence of any sequelae or complications.