摘要
目的 探讨超未成熟(extremely premature,EP)婴儿和超低出生体重(extremely low birth weight,ELBW)婴儿早期存活率及其影响因素.方法 回顾性分析2010年1月至2015年12月山东大学附属省立医院收治的EP婴儿和(或)ELBW婴儿临床资料.根据其生后存活状况分为存活组和死亡组,比较影响两组婴儿存活率的相关因素;再按出生时间分为2014年前和2014年及以后两组,比较两阶段婴儿存活率和围产期早期死亡的影响因素,并对其死因顺位进行分析.结果 研究期间共纳入EP婴儿和(或)ELBW婴儿142例,其中仅符合EP诊断16例(11.3%),仅符合ELBW诊断88例(62.0%),两者均符合38例(26.8%).中位胎龄28(27,29)周,中位出生体重925(830,965)g.存活组76例(53.5%),死亡组66例(46.5%).影响两组婴儿早期存活率的因素为出生体重、胎盘早剥、围产期窒息、早发型脓毒症、肺出血(P均〈0.05).2014年前共纳入EP婴儿和(或)ELBW婴儿67例,存活30例(44.8%);2014年及以后共纳入75例,存活46例(61.3%),两阶段婴儿存活率差异有统计学意义(χ^2=3.900,P=0.048).2014年前死亡组婴儿围产期死亡原因前2位分别是围产期窒息和早发型脓毒症,2014年及以后死因顺位首位是早发型脓毒症.结论 随着早产儿窒息复苏技术的提高和早产儿呼吸支持策略的优化,EP婴儿和(或)ELBW婴儿早期生存率有所提高,早发型脓毒症成为影响该组人群早期存活率的重要因素.
Objective To study the early survival rate and its influencing factors of extremely preterm infants and extremely low birth weight ( ELBW ) infants.Method All extremely preterm infants and/or ELBW infants in Shandong Provincial Hospital from January , 2010 to December 2015 were studied retrospectively.The factors affecting their survival rate and their complications were analyzed retrospectively . All cases were assigned into the survival group and the death group .On the other hand , they were also assigned into two groups according to their birth , pre-2014 and post-2014.Result A total of 142 extremely preterm infants and/or ELBW infants were enrolled, their gestational age was 28 (27, 29) weeks, birth weight was 925 (830, 965) g.76 cases (53.5%) survived, 66 cases (46.5%) died.Factors associated with the survival rate were early onset sepsis , placental abruption , perinatal asphyxia , birth weight and pulmonary hemorrhage (P〈0.05).There were 67 cases pre-2014 in which 30 cases survived (44.8%), while 75 cases post-2014 in which 46 cases survived ( 61.3%) .Comparative analysis between the two groups pre-2014 and post-2014 revealed that the survival rate was significantly different (χ^2 =3.900, P=0.048).The top 2 underlying causes of death before 2014 were perinatal asphyxia and early onset sepsis . Furthermore, early onset infection became the first cause of death after 2014.Conclusion Along with the prevalence of neonatal resuscitation program and the optimization of respiratory support strategies in premature infants , the early survival rate of extremely preterm infants and /or ELBW infants has improved significantly.However, early onset sepsis may have been the crucial cause for their perinatal mortality .
基金
山东省科技发展计划(2014GSF118110)
山东省计生委科技计划项目(2014JS46)
济南市科技局临床医学科技创新计划(201602160)
关键词
婴儿
超低出生体重
存活率
早发型脓毒症
超未成熟儿
影响因素
Infant
extremely low birth weight
Survival rate
Early onset sepsis
Infant
extremely premature
Influence factors