超早产儿及超低出生体质量儿临床分析

Clinical analysis of extremely premature infants and extremely low birth weight infants

目的分析超早产儿(EPI)和超低出生体质量儿(ELBWI)住院期间的并发症及转归。方法对陕西省4家三级甲等医院2015年1月1日至2017年12月31日收治的168例EPI和ELBWI的临床资料进行回顾性分析,总结患儿一般资料及产前、住院并发症和转归情况,按照出生体质量、胎龄进行分组,比较不同组别间转归情况。结果共收集168例EPI和ELBWI,三级医院分娩率为86.9%(146/165例),86例(57.7%)产前使用了地塞米松。168例EPI和ELBWI胎龄(27.9±1.7)周,出生体质量(951.6±148.9)g。产妇孕产期并发症发生率前3位依次为妊娠高血压病(44/149例,29.5%)、胎膜早破(43/149例,28.9%)和妊娠期糖尿病(16/149例,10.7%)。新生儿主要并发症前3位为新生儿呼吸窘迫综合征(16/168例,95.2%)、支气管肺发育不良(73/110例,66.4%)和早产儿视网膜病变(65/110例,59.1%)。168例EP和ELBWI救治存活率为61.9%(104/168例),放弃治疗率为27.4%(46/168例),住院病死率为10.7%(18/168例)。按照出生体质量、胎龄进行分组,不同出生体质量存活、放弃及院内病死率比较差异均无统计学意义(χ^2=4.361、5.104、1.630,均P>0.05),不同胎龄组患儿存活、放弃及院内病死率比较差异均有统计学意义(χ^2=21.650、8.164、13.490,均P<0.05)。结论ELBWI和EPI的并发症多,转归与出生胎龄密切相关,提高围生管理水平及新生儿科专业诊疗水平有助于提高存活率、改善整体预后。

Objective To analyze the complications and outcomes during the hospitalization of extremely premature infants(EPI)and extremely low birth weight infants(ELBWI).Methods Clinical data of 168 cases of EPI and ELBWI admitted to 4 hospitals of grade three in Shaanxi Province between January 1,2015 and December 31,2017 were retrospectively analyzed.The information of general data,prenatal care,complications and outcomes were summarized.Outcomes of different groups were compared according to birth weight and gestational age.Results A total of 168 cases of EPI and ELBWI were collected.The rate of delivery in tertiary hospitals was 86.9%(146/165 cases),86 patients(57.7%)received prenatal Dexamethasone.The mean gestational age was(27.9±1.7)weeks,and the mean birth weight was(951.6±148.9)g.The highest rates of pregnancy complications included gestational hypertension(44/149 cases,29.5%),premature rupture of membranes(43/149 cases,28.9%)and gestational diabetes(16/149 cases,10.7%).The first three neonatal complications were neonatal respiratory distress syndrome(16/168 cases,95.2%),bronchopulmonary dysplasia(73/110 cases,66.4%)and retinopathy of prematurity(65/110 cases,59.1%).The survival rate of EP and ELBWI in 168 cases was 61.9%(104/168 cases),the abandonment rate was 27.4%(46/168 cases),and the mortality in hospital was 10.7%(18/168 cases).According to birth weight and gestational age,there were no statistically significant differences in survival,abandonment and hospital mortality among different birth weight groups(χ^2=4.361,5.104,1.630,all P>0.05),while there were statistically significant differences in survival,abandonment and hospital mortality among different gestational age groups(χ^2=21.650,8.164,13.490,all P<0.05).Conclusions There are many complications of EPI and ELBWI and the outcomes are closely related to the gestational age of birth.Improving the perinatal management level and the professional diagnosis and treatment level of neonatology are helpful to improve the survival rate and prognosis.