超早产儿生存状况及影响因素分析

Analysis of survival status and influencing factors of extremely preterm infants

目的探讨超早产儿的生存状况及其影响因素。方法回顾性分析2016年1月—2018年12月苏州市立医院新生儿重症监护病房住院的超早产儿70例的临床资料,将治愈出院及好转出院者纳入存活组(55例),抢救无效死亡和病情处于临终时放弃治疗后死亡者纳入死亡组(15例)。比较两组超早产儿母亲的妊娠、超早产儿住院期间状况及主要并发症的差异,并采用多因素Logistic回归分析探讨超早产儿死亡的高危因素。结果70例超早产儿胎龄23~27+6周,平均(26.4±0.9)周,出生体重580~1450 g,平均(983±183)g,存活率为78.6%(55/70)。单因素分析结果显示,超早产儿存活组和死亡组胎龄、多胎、新生儿窒息、重度窒息、产前使用激素、新生儿坏死性小肠结肠炎(NEC)、肺出血、机械通气率、机械通气时间、住院时间比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果提示,双胎[OR=5.574(95%CI:1.270,24.460)]、NEC[OR=5.146(95%CI:1.016,16.049)]、肺出血[OR=6.861(95%CI:1.359,36.645)]为超早产儿死亡的高危因素。结论超早产儿病死率较高,双胎妊娠、肺出血及NEC为超早产儿死亡的高危因素。

Objective To explore the survival status of extremely preterm infants(EPT) and its influencing factors. Methods Retrospectively analyze the clinical and laboratory data of EPT admitted to the neonatal intensive care unit(NICU) in Suzhou Municipal Hospital from January 2016 to December 2018. They were divided into death group and survival group, and the clinical data were compared. Results Among 70 cases of EPT, there were 15 in the death group and 55 in the survival group. The gestational age was 23 to 27+6 weeks, the average gestational age was(26.4 ± 0.9) weeks, the birth weight was(580 to 1,450) g, the average birth weight was(983 ± 183) g, and the survival rate was 78.6%. Univariate analysis showed that twins, gestational age,neonatal asphyxia, maternal prenatal hormone use, NEC, pulmonary hemorrhage, mechanical ventilation and ventilation time, length of stay were statistically significant between the death group and the survival group.Moreover, multivariate logistic regression analysis showed that twins [ OR = 5.574(95% CI: 1.270, 24.460) ],NEC [OR = 5.146(95% CI: 1.016, 16.049) ], and pulmonary hemorrhage [OR= 6.861(95% CI: 1.359, 36.645) ]were independent risk factors. Conclusions The mortality rate of EPT is relatively high. Twin pregnancy,pulmonary hemorrhage, and NEC are high risk factors for death of EPT.