新生儿科住院死亡患儿的相关因素分析

Analysis of the correlative factors of neonatal deaths in neonatology department

目的 分析新生儿科住院死亡患儿的相关因素,为提高新生儿救治水平和降低住院病死率提供参考.方法 回顾性调查广州医科大学附属第三医院新生儿科2009-2015年住院期间死亡患儿的住院资料和死亡评审资料,依据其死亡前接受的治疗措施分为安慰治疗、放弃积极治疗和积极救治无效3种类型,总结并用x2检验比较不同治疗类型在各年度、死亡时（日）龄、出生胎龄、出生体重的分布差异和直接死亡原因.结果 共337例死亡患儿入选,其中安慰治疗112例（33.2％）,放弃积极治疗73例（21.7％）,积极救治无效152例（45.1％）.2013-2015年与2009-2012年比较,安慰治疗的构成比增加（38.9％比27.2％,P=0.023）,积极救治无效的构成比降低（38.3％比52.5％,P =0.009）,放弃积极治疗的构成比差异无统计学意义（22.9％比20.4％,P=0.580）.死亡日龄≤7d与〉7d比较,安慰治疗的构成比增加（42.9％比9.3％,P〈0.001）,放弃积极治疗和积极救治无效的构成比降低（17.9％比30.9％,P=0.009;39.2％比59.8％,P=0.001）.随着出生胎龄和出生体重的降低,安慰治疗的构成比增加（P =0.001与P=0.002）.34例足月儿中,排在前2位的直接死亡原因为重度窒息14例（41.1％）、先天性缺陷11例（32.4％）;303例早产儿中,排在前3位的直接死亡原因为新生儿呼吸窘迫综合征95例（31.4％）、新生儿肺出血68例（22.4％）、先天性缺陷19例（6.3％）.结论 安慰治疗和放弃积极治疗在死亡患儿中的构成比较高,且与出生胎龄、体重相关;早产儿是死亡的主要群体,尤其是极/超早产儿和极/超低出生体重儿;新生儿呼吸窘迫综合征、出生时重度窒息分别是早产儿和足月儿的首位直接死亡原因.

Objective To analyze the correlative factors of neonatal deaths in neonatology department to improve the treatment level and reduce the death rate of the hospitalized newborn patients.Method The medical records and death review data of the infants who died in the neonatology department of the Hospital from 2009 to 2015 were retrospectively reviewed.They were assigned to three groups according to the therapeutic measures before their death,including comfort care group,do not resuscitate （DNR） group and active treatment group.Gestational age,birth weight,postnatal age at death and the direct cause of death were compared between groups by x2 test.Result A total of 337 infants were enrolled in this study.There were 112 cases （33.2%） in the comfort care group,73 cases （21.7%） in the DNR group and 152 cases （45.1%） in the active treatment group.Compared to the proportion of the different group during 2009-2012,the proportion of the comfort care group during 2013-2015 significantly increased（38.9% vs.27.2%,P =0.023）,and the proportion of the active treatment group significantly decreased （38.3% vs.52.5%,P =0.009）,while the proportion of the DNR group showed no significant difference （22.9% vs.20.4%,P =0.580）.The proportion of the comfort care group was significantly higher in the group of neonates who died in early neonatal period than that in the late neonatal period and post-neonatal period （42.9% vs.9.3%,P 〈0.001）,while the proportion of the active treatment group and DNR group decreased（17.9% vs.30.9%,P =0.009;39.2% vs.59.8%,P =0.001）.The proportion the comfort care group increased with the decrcasing gestational age and birth weight （P =0.001 and 0.002）.Of the 34 term infants,the top two principle causes of death were severe asphyxia （4.1.1%,14.cases） and congenital defects （32.4%,11 cases）.Of the 303 preterm infants,the top three direct causes of death were neonatal respiratory distress syndrome （31.4%,95 cases）,neonatal pulmonary hemorrhage （22.4%,68 cases） and congenital defects （6.3%,19 cases）.Conclusion The proportion of comfort care and DNR was higher than the proportion of active treatment before the newborns＇ death and it was relative to gestational age and birth weight.Preterm infants were the predominant population of the infant deaths in the neonatology department.Neonatal respiratory distress syndrome was the principle cause of death in preterm infants,and severe asphyxia was the main cause of death in term infants.