西藏地区新生儿窒息预后不良的预测指标及影响因素

Predictors and influencing factors of poor prognosis of neonatal asphyxia in Tibet

目的探讨西藏地区新生儿窒息预后不良的预测指标及相关因素。方法选取2019年3月至2020年3月拉萨市人民医院新生儿科收治的126例窒息新生儿的临床资料进行回顾性研究,根据预后情况分为预后不良组和预后良好组。比较两组临床特征,分析出生后Apgar评分、出生后6 h内动脉血气分析[pH、碱剩余(BE)]及两者联合检测对窒息新生儿预后的预测价值;logistic回归分析影响窒息新生儿预后的相关因素。结果预后不良组31例(24.6%),预后良好组95例(75.4%)。预后不良组出生后1、5、10 min Apgar评分和出生后6 h内pH、BE明显低于预后良好组,羊水粪染、胎儿宫内窘迫的发生率以及窒息后脑损害、肺损害、心肌损害、肾脏损害、凝血功能异常、多器官损害的发生率明显高于预后良好组,差异均有统计学意义(均P<0.05)。出生后1、5、10 min Apgar评分与出生后6 h内动脉血气分析(pH、BE)联合检测对新生儿窒息的预后有较高的预测价值,受试者工作特征曲线的曲线下面积为0.79,灵敏度为68.4%,特异度为90.3%。多因素回归分析显示羊水粪染(OR=4.501,95%CI:1.262~16.056)、肺损害(OR=5.004,95%CI:1.007~24.866)、脑损害(OR=10.786,95%CI:2.726~42.673)是影响新生儿窒息预后的独立危险因素(P<0.05)。结论在西藏地区,影响新生儿窒息预后不良的因素很多,应早期对母亲围产期和窒息新生儿给予高度关注及干预,以降低新生儿窒息预后不良的发生率。

Objective To explore the prognostic indicators and influencing factors of neonatal asphyxia in Tibet.Methods From March 2019 to March 2020,the clinical data of 126 asphyxiated newborns admitted to the neonatology department of Lhasa People's Hospital were retrospectively studied.According to the prognosis,they were divided into good prognosis group and poor prognosis group,and the clinical characteristics of the two groups were compared.The predictive value of Apgar score after birth,arterial blood gas analysis within 6 hours[pH,alkali residue(BE)]and their combined detection on the prognosis of asphyxiated newborns was analyzed.Logistic regression analysis was used to analyze the related factors affecting the prognosis of asphyxiated newborns.Results 31 cases(24.6%)in the poor prognosis group and 95 cases(75.4%)in the good prognosis group.The Apgar score at 1,5 and 10 minutes after birth and pH and BE within 6 hours in the poor prognosis group were significantly lower than those in the good prognosis group(all P<0.05).The incidence of meconium stained amniotic fluid,fetal intrauterine distress,brain damage,lung damage,myocardial damage,kidney damage,abnormal coagulation function and multiple organ damage after asphyxia in the good prognosis group were significantly higher than those in the good prognosis group(all P<0.05).The Apgar score at the 1,5 and 10 minutes after birth combined with arterial blood gas analysis(pH and BE)within 6 hours after birth had high predictive value for the prognosis of asphyxiated newborns,with the area under receiver operating characteristic(ROC)curve of 0.79,sensitivity of 68.4% and specificity of 90.3%.Multivariate regression analysis showed that meconium stained amniotic fluid(OR=4.501,95%CI:1.262-16.056),lung damage(OR=5.004,95%CI:1.007-24.866)and brain damage(OR=10.786,95%CI:2.726-42.673)were independent risk factors affecting the prognosis of neonatal asphyxia(P<0.05).Conclusions In Tibet,there are many factors affecting the poor prognosis of neonatal asphyxia.High attention and intervention should be given to mothers in perinatal period and asphyxiated newborns in order to reduce the incidence of poor prognosis of neonatal asphyxia.