超早产儿出生窒息的危险因素分析

Analysis of risk factors of birth asphyxia in extremely premature infants

目的探讨超早产儿发生出生窒息的危险因素。方法选取2017年1月至2020年6月,解放军总医院第七医学中心儿科医学部超早产重症监护病房收治的超早产儿为研究对象,纳入窒息组184例,对照组153例。回顾性收集超早产儿及其母亲的临床资料,分析超早产儿发生出生窒息的危险因素。统计学方法采用t检验、χ^(2)检验、单自变量和多自变量二元Logistic分析。结果窒息组孕妇妊娠期高血压疾病的发生率高于对照组[19.0%(35/184)与9.2%(14/153),χ^(2)=6.551,P=0.010],孕期感染的发生率低于对照组[10.9%(20/184)与19.0%(29/153),χ^(2)=4.394,P=0.036]。窒息组超早产儿的出生胎龄和出生体质量均低于对照组[出生胎龄(26.4±1.2)与(26.9±0.9)周,t=–3.88,P<0.001;出生体质量(936±194)与(999±177)g,t=–3.058,P=0.002],脐带异常的比例高于对照组[18.5%(34/184)与10.5%(16/153),χ^(2)=4.253,P=0.039]。以新生儿是否发生窒息为因变量,将单因素分析中P<0.1的因素纳入模型,进一步做单自变量和多自变量二元Logistic分析。在单自变量回归分析中,出生胎龄、出生体质量、脐带异常、妊娠期高血压疾病、孕期感染与超早产儿发生窒息相关(OR值分别为0.675、0.998、1.941、2.332和0.521,P值均<0.05)。在多自变量回归分析中,出生胎龄与窒息发生呈负相关(OR=0.719,P=0.004),脐带异常与窒息发生呈正相关(OR=2.172,P=0.024)。结论导致超早产儿出生窒息的危险因素主要有出生胎龄、脐带异常等。及早预防和治疗妊娠期合并症和并发症,对降低早产及出生窒息的发生有重要意义。

Objective To explore the risk factors of birth asphyxia in extremely premature infants.Methods From January 2017 to June 2020,extremely premature infants admitted to the Intensive Care Unit of Extremely Premature Infants,Senior Department of Pediatrics,the Seventh Medical Center of PLA General Hospital were selected as the study subjects,including 184 cases in the asphyxia group and 153 cases in the control group.The clinical data of extremely premature infants and their mothers were retrospectively collected to analyze the risk factors of birth asphyxia in extremely premature infants.Statistical methods of t test,χ^(2) test,univariate and multivariate binary Logistic analysis were used.Results The incidence of hypertension during pregnancy in asphyxia group was higher than that in control group[19.0%(35/184)vs 9.2%(14/153),χ^(2)=6.551,P=0.010],and the incidence of infection during pregnancy was lower than that in control group[10.9%(20/184)vs 19.0%(29/153),χ^(2)=4.394,P=0.036].The gestational age and birth weight of extremely premature infants in asphyxia group were lower than those in control group[gestational age(26.4±1.2)vs(26.9±0.9)weeks,t=–3.88,P<0.001;birth weight(936±194)vs(999±177)g,t=–3.058,P=0.002],while the proportion of abnormal umbilical cord was higher than that of the control group[18.5%(34/184)vs 10.5%(16/153),χ^(2)=4.253,P=0.039].With the occurrence of neonatal asphyxia as the dependent variable,factors with P<0.1 in univariate analysis were included into the model,and further univariate and multivariate binary Logistic analysis was conducted.In univariate regression analysis,gestational age,birth weight,abnormal umbilical cord,hypertensive diseases during pregnancy and infection during pregnancy were correlated with asphyxia of extremely premature infants(OR values were 0.675,0.998,1.941,2.332 and 0.521,respectively,all P<0.05).In multivariate regression analysis,gestational age was negatively correlated with asphyxia(OR=0.719,P=0.004),and umbilical cord abnormality was positively correlated with asphyxia(OR=2.172,P=0.024).Conclusion The risk factors of birth asphyxia in extremely premature infants are gestational age and abnormal umbilical cord.Early prevention and treatment of complications during pregnancy is of great significance to reduce the occurrence of premature delivery and birth asphyxia.