新生儿困难复苏相关危险因素分析

Analysis of related risk factors of neonatal resuscitation difficulty

目的 分析新生儿困难复苏的相关危险因素.方法 以2011 年1 月至2015 年10 月分娩的活产满28 周窒息儿（1 分钟Apgar 评分0 - 7 分）为研究对象,经复苏后,以5 分钟Apgar 评分8 - 10 分新生儿为5 分钟复苏顺利组,0 - 7 分新生儿为5 分钟复苏困难组,进行相关危险因素的分析;5 分钟复苏困难新生儿继续复苏后,20 分钟Apgar 评分8 - 10 分的新生儿列为20 分钟复苏顺利组,0 - 7 分新生儿为20 分钟复苏困难组,再进行危险因素分析.结果 纳入1 分钟窒息新生儿743例,其中5 分钟复苏困难新生儿130 例,另外613 例复苏顺利,早产、低出生体质量、1 分钟Apgar 评分0 - 3 分、产时感染性发热、胎盘异常、妊娠后期阴道出血、双胎输血综合征、胎儿畸形与5 分钟复苏困难有明显的相关性（P均 〈 0.05）.5 分钟复苏困难新生儿继续复苏后,20分钟复苏困难新生儿32例,与复苏顺利组新生儿98例比较,两组在1分钟Apgar评分0 - 3分、5 分钟Apgar 评分0 - 3 分方面比较差异均有统计学意义（P均〈 0.05）.1 分钟窒息新生儿中的2 例前置血管和8 例胎儿水肿新生儿,在5分钟和20分钟仍复苏困难.结论 窒息新生儿复苏影响因素较多,其中前置血管、胎儿水肿所致窒息复苏困难.

Objective To analyze related risk factors in resuscitation difficulty in neonates.MethodsLive birth asphyxia neonates with gestational age≥28 weeks (1 minute Apgar score count of 0-7) were included during January 2011 to October 2015. After resuscitation, the neonates were divided into two groups by 5 minutes Apgar score, successful resuscitation group (Apgar score of 8-10) and poor resuscitation group (Apgar score of 0-7). The analysis of related risk factors was performed. Neonates with poor resuscitation assessed by 5 minutes Apgar were continued being resuscitated. After 20 minutes, these neonates were divided into successful resuscitation group (20 minutes Apgar 8-10) and poor resuscitation group (20 minutes Apgar 0-7). The related risk factors analysis was performed once again. ResultsA total of 743 neonates with asphyxia at one minute were included, among whom 130 cases were poor resuscitation and 613 cases were successful resuscitation at 5 minutes. There were obvious correlations of 5 minutes poor resuscitation with premature delivery, low birth weight, 1 minute Apgar score for 0?~?3, intrapartum infectious fever, abnormal placenta, vaginal bleeding during late pregnancy, twin transfusion syndrome, and fetal malformation (P all?<?0.05). Neonates with 5 minutes poor resuscitation continued being resuscitated, 32 cases were still poor resuscitation at 20 minutes, and compared with 98 cases of successful resuscitation, there were statistical differences in 1 minute and 5 minutes Apgar score of 0?~?3 (P all?<?0.05). Two cases of vasa praevia and eight cases of fetal edema neonates were still poor resuscitation at 5 minutes and 20 minutes who were asphyxia at one minute.ConclusionThere are many factors affecting the resuscitation of asphyxia neonates, among which vasa praevia and fetal edema are most adverse factor in neonatal resuscitation dififculty.