早产极低体质量儿宫外发育迟缓的影响因素分析

Analysis of influencing factors of extra uterine growth retardation in premature very low birth weight infants

目的 分析早产极低体质量儿宫外发育迟缓（EUGR）的影响因素.方法 选取漯河市第三人民医院重症监护病房住院存活的61例EUGR早产极低体质量儿为研究对象,设为EUGR组（n=61）,另选同期住院的未发生EUGR的早产极低体质量儿50例为非EUGR组（n=50）.收集并分析两组患儿的临床相关病历资料,比较两组相关资料的差异,分析EUGR发生的影响因素,并行Logistic多因素回归分析.结果 EUGR组出生胎龄为（31.29±1.56）周,明显短于非EUGR组的（33.98±1.35）周,差异有统计学意义（t=9.60,P〈0.05）;EUGR组出生体质量为（1 206.76±212.14）g,明显低于非EUGR组的（1 341.55±103.26）g,差异有统计学意义（t=4.11,P〈0.05）;EUGR组住院时间、恢复到出生体质量时间、开始肠内营养时间、全胃肠营养时间分别为（27.77±5.00）d、（15.36±5.91）d、（3.36±1.91）d、（16.93±4.02）d,均明显长于非EUGR组的（22.69±3.97）d、（10.61±4.57）d、（2.61±1.37）d、（9.43±3.11）d,差异均有统计学意义（t=3.53、4.65、2.33、10.80,均P〈0.05）.EUGR组宫内发育迟缓发生率为52.46%,明显高于非EUGR组的6.00%,差异有统计学意义（x2=27.47,P〈0.05）;EUGR组呼吸系统、消化系统、代谢性紊乱合并症发生率分别为26.23%、19.67%、67.21%,均明显高于EUGR组的8.00%、6.00%、40.00%,差异均有统计学意义（x2=6.18、4.39、8.22,均P〈0.05）.Logistic回归分析显示,低胎龄、低出生体质量、住院时间长、恢复到出生体质量和全胃肠营养时间晚、宫内发育迟缓及呼吸系统、消化系统、代谢性紊乱合并症是EUGR发生的独立危险因素（P〈0.05）.结论 早产极低体质量儿EUGR的影响因素主要有低胎龄、低出生体质量、住院时间长、恢复到出生体质量和全胃肠营养时间晚、宫内发育迟缓及呼吸系统、消化系统、代谢性紊乱合并症,临床应给予积极对症措施进行预防干预.

Objective To analyze the influencing factors of extra uterine growth retardation （EUGR） in premature very low birth weight infants.Methods A total of 61 EUGR premature very low birth weight infants survived in intensive care unit of our hospital were enrolled into EUGR group,and at the same time another 50 non-EUGR premature very low birth weight infants were selected into non-EUGR group.The clinical related medical records in the two groups were compared and analyzed,and the influencing factors of EUGR was analyzed by Logistic regression analysis.Results The birth gestational age of EUGR group was （31.29±1.56）weeks,which was significantly lower than （33.98±1.35）weeks of the non-EUGR group （t=9.60,P〈0.05）.The birth weight of the EUGR group was （1 206.76±212.14）g,which was significantly lower than （1 341.55±103.26）g of the non-EUGR group （t=4.11,P〈0.05）.The hospital stay,return to birth weight time,start enteral nutrition time and total parenteral nutrition time in the EUGR group were （27.77±5.00）d,（15.36±5.91）d,（3.36±1.91）d,（16.93±4.02）d respectively,which were significantly longer than those in the non-EUGR group[22.69±3.97）d,（10.61±4.57）d,（2.61±1.37）d,（9.43±3.11）d]（t=3.53,4.65,2.33,10.80,all P〈0.05）.The incidence rates of complications such as respiratory system,digestive system and metabolic disorder in the EUGR group were 26.23%,19.67% and 67.21%,respectively,which were significantly higher than those of the non-EUGR group（8.00%,6.00% and 40.00%）（x2=6.18,4.39,8.22,all P〈0.05）.Logistic regression analysis showed that low birth gestational age and birth weight,long hospital stay,later return to birth weight and total parenteral nutrition time,intrauterine growth retardation,and respiratory system,digestive system and metabolic disorder were independent risk factors for the occurrence of EUGR（all P〈0.05）.Conclusion The influencing factors of EUGR in very low birth weight infants were mainly low gestational age and birth weight,long hospital stay,later return to birth weight and total parenteral nutrition time,intrauterine growth retardation,and respiratory system,digestive system and metabolic disorder.Therefore,in order to prevent EUGR,active symptomatic measures should be given in clinic.