新生儿窒息相关影响因素及防控对策研究

Study on Influencing Factors and Prevention and Control Strategies of Neonatal Asphyxia

目的研究新生儿窒息发生的相关影响因素,并总结防控对策。方法采用整群抽样法在张掖市的5家医院于2021年3月至2023年10月出生的新生儿中选取研究对象,选取张掖市的市、区、县不同级别医院5家,不同级别医院分别抽取2000例(一家市级三甲),1000例(一家区三乙)、1000例(三家县级二甲),采用统一的问卷调查新生儿的人口学资料,孕妇的孕期情况等,通过Logistic回归模型调查新生儿窒息发生的影响因素。结果本组4000例新生儿中,新生儿窒息发生率为5.43%,且轻度窒息占92.17%,重度窒息仅占7.83%,因窒息死亡的概率为0.92%。经单因素分析,母亲年龄、文化背景、孕期产检次数、合并妊娠期感染、妊娠期糖尿病、妊娠期甲功异常、家庭年收入、胎盘前置、胎盘早剥、宫内窘迫、羊水污染、羊水过多、胎位不正、产程延长、脐带脱垂、胎龄、分娩时间、分娩医院以及新生儿性别都会影响新生儿窒息的发生(P<0.05);而多因素Logistic回归分析显示:母亲妊娠期感染、家庭年收入<3万元、胎盘前置、胎盘早剥、宫内窘迫、羊水污染、脐带脱垂、胎龄<37周均是影响新生儿窒息发生的独立危险因素(P<0.05)。对出生后发生重度窒息的新生儿开展积极准确快速的复苏是降低近远期脑损伤的重要保障。结论新生儿窒息的发生影响因素众多,孕妇应加强围生期的保健管理,定期产检,医护人员密切关注产程进展,提高急救技能,降低新生儿窒息发生率。

Objective To study the relevant influencing factors of neonatal asphyxia and summarize prevention and control strategies.Methods Cluster sampling was used to select from 5 hospitals in Zhangye,China,who were born between March 2021 and October 2023,five hospitals at different levels of city,district,and county in Zhangye city were selected,with 2000 cases(one city level grade 3A),1000 cases(one district grade 3B),and 1000 cases(three county-level grade 2A)selected as the subjects.A unified questionnaire survey was used to investigate the demographic data of newborns and the pregnancy situation of pregnant women.Logistic regression models were used to investigate the influencing factors of neonatal asphyxia.Results Among the 4000 newborns in this group,the incidence of neonatal asphyxia was 5.43%,with mild asphyxia accounting for 92.17%and severe asphyxia only accounting for 7.83%.The probability of death due to asphyxia was 0.92%.By univariate analysis,maternal age,cultural background,the number of prenatal examinations during pregnancy,combined pregnancy infection,pregnancy diabetes,abnormal thyroid function during pregnancy,annual family income,placenta previa,placental abruption,intrauterine distress,amniotic fluid pollution,polyhydramnios,fetal malposition,prolonged labor process,umbilical cord prolapse,gestational age,delivery time,delivery hospital and newborn gender all affect the occurrence of neonatal asphyxia(P<0.05);Multivariate logistic regression analysis showed that maternal infection during pregnancy,family annual income<30000 yuan,placenta previa,placental abruption,intrauterine distress,amniotic fluid contamination,umbilical cord prolapse,and gestational age<37 weeks were all independent risk factors for neonatal asphyxia(P<0.05).Active,accurate,and rapid resuscitation in the event of severe asphyxia after birth is an important and beneficial guarantee for reducing short-term and long-term brain injury.Conclusions There are many factors that affect the occurrence of neonatal asphyxia.Pregnant women should strengthen their health management during the perinatal period,undergo regular prenatal examinations,and medical staff should closely monitor the progress of the labor process,improve emergency skills,and reduce the incidence of neonatal asphyxia.