新生儿缺氧缺血性脑病发病及预后影响因素分析

Analysis of the risk factors in the incidence and prognosis of neonatal hypoxic ischemic encephalopathy

目的探讨新生儿缺氧缺血性脑病(HIE)的发病危险因素及预后影响因素。方法选择2014年1月至2016年1月黄冈市中心医院收治的新生儿HIE 120例为HIE组,另选择同期健康新生儿120例为对照组,分析HIE的发病危险因素及预后影响因素。结果单因素分析结果显示,产妇文化程度、产科检查、产程、孕期贫血、胎膜早破、脐带异常、胎盘异常、妊娠期糖尿病、妊娠期高血压、羊水污染、宫内窘迫、新生儿窒息、1 min Apgar评分、5 min Apgar评分及催产素使用情况与新生儿HIE的发病有关(P<0.05),而产妇年龄与新生儿HIE的发病无关(P>0.05)。Logistic回归分析显示,孕期贫血、胎膜早破、脐带异常、胎盘异常、妊娠期高血压、羊水污染、宫内窘迫、新生儿窒息、产程异常及Apgar评分是新生儿HIE发病的独立危险因素(P<0.05)。120例HIE新生儿,预后良好102例,预后不良18例,预后良好率为85.0%(102/120)。单因素分析结果显示,患儿5 min Apgar评分、HIE分度、开始治疗日龄及并发症与HIE新生儿预后有关(P<0.05)。多因素logistic回归分析显示,Apgar评分、HIE分度、开始治疗日龄及并发症是影响HIE新生儿预后的独立危险因素(P<0.05)。结论新生儿HIE的发病和预后与多种因素有关。加强围生期保健和产时监护、及时干预危险因素可以改善患儿预后。

Objective To explore the risk factors in the incidence and prognosis of neonatal hypoxic ischemic encephalopathy（ HIE）. Methods A total of 120 neonates with HIE in Huanggang Central Hospital from January 2015 to January 2016 were selected as HIE group,another 120 healthy neonates were selected as control group. The risk factors in the occurrence and prognosis of neonatal HIE were analyzed. Results Univariate analysis showed that maternal education,obstetric examination,labor,anemia during pregnancy,premature rupture of membranes,umbilical cord abnormality,anomaly of placenta,gestational diabetes mellitus,gestational hypertension,amniotic fluid pollution,fetal distress,neonatal asphyxia,1 min and 5 min Apgar scores,oxytocin were associated with the incidence of neonatal HIE（ P〈0. 05）; but maternal age was not associated with the incidence of neonatal HIE（ P〈0. 05）. Logistic regression analysis showed that anemia during pregnancy,premature rupture of membranes,umbilical cord abnormality,anomaly of placenta,gestational hypertension,amniotic fluid pollution,fetal distress,neonatal asphyxia,abnormal labor and Apgar score were the independent risk factors for the incidence of neonatal HIE（ P〈0. 05）. Among the 120 neonates with HIE,the prognosis was good in 102 cases,the prognosis was poor in 18 cases,and the good prognosis rate was 85. 0%（ 102/120）. Univariate analysis showed that 5 min Apgar score,HIE degree,the age of starting treatment and complications were associated with the prognosis of neonatal HIE（ P〉0. 05）. Logistic regression analysis showed that the Apgar score,HIE degree,the age of starting treatment and complications were the independent risk factors for the prognosis of neonatal HIE（ P〈0. 05）. Conclusion The incidence and prognosis of neonatal HIE are related to many factors.Strengthening perinatal health care and intrapartum monitoring,timely intervention of risk factors can improve the prognosis of HIE neonates.