产前和产时高危因素分层评分对新生儿复苏呼吸支持的预测价值

Predictive value of prenatal and perinatal stratified score of high-risk factors for breath support in neonatal resuscitation

目的 分析产前和产时高危因素分层评分对新生儿复苏呼吸支持的预测价值。方法 选取2021年1月—2022年3月在银川市妇幼保健院产科病房分娩的2 035例新生儿为研究对象,按照是否需要呼吸支持,分为呼吸支持组(186例)和对照组(1 849例),收集产前和产时高危因素,分析高危因素分层评分预测新生儿呼吸支持的灵敏度与特异度。结果 足月选择性剖宫产,足月试产失败的紧急剖宫产,脐带脱垂、前置胎盘或胎盘早剥,胎儿心率异常,<34周正常分娩,<37周选择性或紧急剖宫产,胎儿有使用胎吸或产钳的指征是新生儿产时高危因素(均P<0.05)。<35周多胎妊娠是新生儿产前高危因素(χ^(2)=4.882,P<0.05)。呼吸支持组新生儿产前和产时高危因素分层评分为(3.61±1.54)分,对照组新生儿产前和产时高危因素分层评分为(1.97±1.12)分,差异有统计学意义(t=-18.150,P<0.05)。受试者工作特征(ROC)曲线结果显示:产前和产时高危因素分层评分可以作为预测新生儿是否需要呼吸支持的指标[曲线下面积(AUC)=0.814,P<0.05,95%CI:0.783~0.845]。根据约登指数判断高危因素分层评分的临界值为3分,灵敏度为79.01%,特异度为76.53%。结论 产前和产时高危因素分层评分可以作为预测新生儿复苏是否需要呼吸支持的指标。

Objective To analyze the predictive value of prenatal and perinatal stratified score of high-risk factors for breath support in neonatal resuscitation.Methods A total of 2 035 neonates giving birth to their babies in maternity ward of Yinchuan Women and Children Health Care Hospital from January 2021 to March 2022 were selected as research object,according to needing breath support or not,the neonates were divided into breath support group(186 cases) and control group(1 849 cases),the prenatal and perinatal high-risk factors were collected,the sensitivity and specificity of stratified score of high-risk factors in predicting neonatal breath support were analyzed.Results Full-term selective cesarean section,emergency cesarean section with failure of full-term trial delivery,prolapse of cord,placenta previa or placental abruption,abnormal fetal heart rate,normal delivery less than 34 gestational weeks,selective or emergency cesarean section less than 37 gestational weeks,having indications of fetal aspiration or forceps were perinatal high-risk factors of neonates(P<0.05).Multiple pregnancy less than 35 gestational weeks was prenatal high-risk factors of neonates(χ^(2)=4.882,P<0.05).Stratified score of prenatal and perinatal high-risk factors in breath support group was(3.61±1.54),stratified score of prenatal and perinatal high-risk factors in control group was(1.97±1.12),there was statistically significant difference(t=-18.150,P<0.05).The results of receiver operating characteristic(ROC) curve showed that stratified score of prenatal and perinatal high-risk factors could be used to predict needing breath support or not in neonates [the area under ROC curve(AUC)=0.814,P<0.05,95% CI:0.783-0.845].According to Jordan index,the critical value of stratified score of high-risk factors was 3 points,the sensitivity was 79.01%,and the specificity was 76.53%.Conclusion Stratified score of prenatal and perinatal high-risk factors can be used as an indicator to predict whether neonates need breath support.