新生儿头颅血肿与围生期相关因素的临床分析

Clinical study in neonatal cephalhematoma and perinatal related factors

目的调查新生儿头颅血肿的发生率,探讨新生儿头颅血肿的发生与围生期因素的关系。方法回顾性分析2016年7月至2018年6月在北京大学国际医院产科经阴分娩的2 492名足月单胎新生儿及其母亲的病历资料,将发生头颅血肿的新生儿作为头颅血肿组,按照1:2的比例选取219名新生儿为对照组进行病例对照研究。采用病例对照研究的方法分析新生儿发生头颅血肿的相关特点。采用Logistic回归分析评估经阴分娩新生儿发生头颅血肿的高危因素。结果经阴分娩未用产钳助产的新生儿头颅血肿发生率为3.99%(90/2 253),使用产钳助产的发生率高达12.97%(31/239),经比较差异有统计学意义(χ~2=13.33,P<0.05)。与对照组相比,头颅血肿组胎膜早破、羊水粪染、胎心减速发生率较高(χ~2值分别为6.26、3.90、11.61),生后1分钟和5分钟Apgar评分较低(t值分别为-3.93、-3.21),两组比较差异均有统计学意义(均P<0.05)。Logistic回归分析显示,产钳助产、胎膜早破、1分钟Apgar低评分均与头颅血肿的发生明显相关(OR值分别为2.268、2.178、0.526,均P<0.05)。结论产钳助产、胎膜早破、1分钟Apgar低评分是新生儿发生头颅血肿的高危因素。新生儿头颅血肿的发生与新生儿窒息密切相关。

Objective To investigate the incidence of neonatal cephalhematoma and explore the relationship between neonatal cephalohematoma and perinatal factors. Methods A retrospective study was conducted on 2 492 full-term singleton neonates naturally delivered in International Hospital of Peking University and their mothers from July 2016 to June 2018. Neonates with cephalohematoma were recruited in cephalohematoma group, and 219 neonates matched by 1:2 were selected in control group for case-control study. Case-control study was used to analyze the characteristics of cephalhematoma. The risk factors for neonatal cephalhematoma were evaluated by using Logistic regression analysis. Results The incidence of cephalohematoma in vaginal deliveries without forceps was 3.99%(90/2 253), while it was 12.97%(31/239) in forceps deliveries. The difference was statistically significant(χ~2=13.33,P<0.05). The incidences of premature rupture of membranes, meconium stained amniotic fluid, and fetal heart deceleration in cephalohematoma group were significantly higher than in the control group(χ~2 value was 6.26, 3.90 and 11.61, respectively, all P<0.05). In cephalohematoma group 1 min and 5 min Apgar scores of cephalohematoma group were significantly lower than the control group(t value was-3.93 and-3.21, respectively, both P<0.05). Multiple Logistic regression analysis showed that forceps delivery, premature rupture of membranes, and 1 low min Apgar score were significantly related to cephalohematoma(OR value was 2.268, 2.178 and 0.526, respectively, all P<0.05).Conclusion Forceps delivery, premature rupture of membranes, and 1 low min Apgar score are risk factors of neonatal cephalhematoma. The occurrence of neonatal cephalhematoma is highly related to birth asphyxia.