影响超早产儿不良结局的产科因素分析

Analysis of Obstetric Factors Influencing Adverse Outcomes of Extremely Preterm Infants

目的:探讨超早产儿不良结局的产科影响因素。方法:回顾性收集2012年1月1日至2021年12月31日在北京大学第三医院产科住院分娩,分娩孕周24^(+0)~27^(+6)周,复苏后转入本院新生儿科积极救治的超早产儿共196例,按照是否存活和有无严重并发症分为不良结局组(n=154)和非不良结局组(n=42),比较两组孕妇临床资料的组间差异,并使用受试者工作特征(ROC)曲线计算分娩孕周和新生儿出生体质量与不良结局的曲线下面积、选取临界值,转换为二分类变量。将单因素分析有意义的因素,纳入多因素Logistic回归分析,筛选出超早产儿不良结局的相关因素。结果:①单因素分析显示孕妇肥胖、产前出血、双胎妊娠、分娩孕周、新生儿出生体质量、1分钟Apgar评分≤7分及新生儿血pH值<7.2与超早产儿的不良结局有关(P<0.05)。②ROC曲线分析,取约登指数最大时分娩孕周26.93周、新生儿出生体质量865 g作为临界值将其转为二分类变量。③多因素Logistic回归分析显示,超早产儿发生不良结局的独立危险因素是双胎妊娠、新生儿出生体质量<865 g、1分钟Apgar评分≤7分。结论:妊娠24~27周因母儿因素需终止妊娠时,应尽可能延长孕周。双胎妊娠、新生儿出生体质量<865 g及低Apgar评分的超早产儿不良结局发生率高,应充分告知病情,给予积极复苏,做好产房过渡期管理。

Objective:To explore the obstetric influencing factors of adverse outcomes in extremely preterm infants.Methods:A total of 196 cases of extremely preterm infant delivered in the Obstetrics Department of Peking University Third Hospital from January 1,2012 to December 31,2021,with a gestational age of 24^(+0)-27^(+6)weeks,and were transferred to the neonatal department of our hospital for active treatment after resuscitation were retrospectively collected.According to survival and serious complications,they were divided into adverse outcome group(n=154)and non-adverse outcome group(n=42).The differences in clinical data of pregnant women between the two groups were compared.The area under the curve for gestational weeks of delivery and neonatal birth weight and adverse outcomes was calculated using the receiver operating characteristic(ROC)curve,and the cut-off values were selected and converted to dichotomous variables.Factors of significance in univariate analysis were included in Logistic regression analysis to screen for factors related to adverse outcomes in extremely preterm infants.Results:①Univariate analysis showed that maternal obesity,antepartum haemorrhage,twin pregnancy,gestational age of delivery,neonatal birth weight,1 minute Apgar score≤7 points and neonatal blood pH<7.2 were associated with adverse outcomes in extremely preterm infants(P<0.05).②ROC curve analysis,taking the maximum gestational week of 26.93 weeks of delivery and the birth weight of 865 g of newborn at the maximum of the Joden index were taken as the cut-off values to convert them into dichotomous variables.③Multivariate Logistic regression analysis showed that the independent risk factors for adverse outcomes in extremely preterm infants were twin pregnancy,neonatal birth weight<865 g,and 1 minute Apgar score≤7 points.Conclusions:The gestational age should be extended as much as possible when the pregnancy needs to be terminated at 24-27 weeks of gestation due to maternal and infant factors.The incidence of adverse outcomes in extremely preterm infants with twin pregnancy,neonatal birth weight<865 g and low Apgar score is high.The condition should be fully informed,active resuscitation should be given,and transitional management of the delivery room should be done.