甘肃甘南高原地区新生儿窒息影响因素分析

Analysis of the risk factors of neonatal asphyxia in southern Gansu province high-altitude area

目的调查甘肃甘南高原地区新生儿窒息患病情况及主要影响因素。方法在甘肃省甘南藏族自治州整群抽样选择高原地区的8家医疗机构，前瞻性选择2016年10～12月住院分娩的活产新生儿及其母亲为研究对象，记录临床资料，通过统一编制的调查问卷对产妇孕期及家庭情况进行调查。应用单因素和多因素Logistic回归分析筛选甘肃甘南高原地区新生儿窒息的影响因素。结果研究期间甘南高原地区分娩的1 197名新生儿中183例发生窒息，占15.3%；其中轻度窒息157例，重度窒息26例。多因素回归分析显示，生活环境在海拔3 000米以下（OR＝2.693，95%CI 1.275～5.689）、母亲孕期发热（OR＝2.986，95%CI 1.163～7.666）、产程延长（OR＝2.925，95%CI 1.112～7.691）、胎儿宫内窘迫（OR＝7.000，95%CI 3.254～15.056）、宫缩乏力（OR＝2.737，95%CI 1.484～5.047）、脐带异常（OR＝3.094，95%CI 2.051～4.668）、羊水异常（OR＝2.033，95%CI 1.230～3.361）、胎盘异常（OR＝2.753，95%CI 1.016～7.464）均是新生儿发生窒息的危险因素，家庭年收入〉30 000元（OR＝0.452，95%CI 0.297～0.687）是新生儿窒息的保护因素。结论甘肃甘南高原地区新生儿窒息发生率高，多与宫内因素和产时因素相关，应加强产前监护，及时处理，减少新生儿窒息的发生。

To study the prevalence and the main risk factors of neonatal asphyxia in southern Gansu province high-altitude area.MethodFrom October 2016 to December 2016, clinical data of neonates born in eight hospitals of the region were analyzed. A uniform questionnaire was used to survey the maternal condition and family background. Univariate and multivariate Logistic regression analysis were used to determine the risk factors of neonatal asphyxia.ResultA total of 183 newborns were born with asphyxia （mild 157 cases, severe 26 cases）, and the incidence of neonatal asphyxia was 15.3% （183/1 197）. The multivariate Logistic regression analysis indicated that the risk factors included altitude less than 3 000 meters （OR=2.693, 95%CI 1.275~5.689）, maternal fever （OR=2.986, 95%CI 1.163~7.666）, prolonged labor （OR=2.925, 95%CI 1.112~7.691）, fetal distress （OR=7.000, 95%CI 3.254~15.056）, uterine inertia （OR=2.737, 95%CI 1.484~5.047）, umbilical cord abnormality （OR=3.094, 95%CI 2.051~4.668）, amniotic fluid abnormality （OR=2.033, 95%CI 1.230~3.361） and placental abnormality （OR=2.753, 95%CI 1.016~7.464）. Annual household income more than 30 000 yuan （OR=0.452, 95%CI 0.297~0.687） was protective factor of neonatal asphyxia.ConclusionThe incidence of neonatal asphyxia was high in the region, which was related to intrauterine and intrapartum factors. Antepartum monitoring and timely treatment should be strengthened to reduce the incidence of newborn asphyxia.