机械通气治疗的新生儿呼吸衰竭患儿智力及发育落后的相关因素分析

Risk factors for intelligence and development retardation of survivals in application of mechanical ventilation for treatment of respiratory failure in newborn

目的探讨新生儿重症监护室(NICU)应用气管插管机械通气治疗的新生儿呼吸衰竭(NRF)患儿智力及发育落后的影响因素。方法选择NICU应用气管插管机械通气治疗的NRF患儿436例,最终成活患儿共随访到193例。探讨住院期间母亲合并症、新生儿的围生期情况、原发病分布状况、机械通气时间、再次插管等各种因素与智力及发育落后的关系。采用单因素及多因素Logistic回归分析其相关危险因素。成活儿出院后予以早期干预指导和随访,校正年龄18个月时进行智能及运动发育测试。结果 436例患儿中,193例患儿随访至出院后校正年龄18个月,随访率69.17%,其中智力异常16例(8.29%)、运动异常36例(18.65%),确诊脑瘫患儿13例(6.74%)。单因素分析发现:胎龄≥37周、气管插管时间≥4 d、缺氧缺血性脑病(HIE)对智力发育均有影响(P均<0.05);而胎龄<37周、颅内出血、再次插管对运动功能有影响(P均<0.05)。193例患儿中,98例存在HIE,进行早期干预53例,其中智力低下4例(7.55%)、运动发育落后9例(16.98);未进行早期干预45例,智力低下12例(26.67%)、运动发育落后27例(60.00%),两者比较,P均<0.001;影响新生儿智力发育的因素分别是机械通气时间(OR=1.183)、早期干预(OR=0.301)、母亲妊高症(OR=1.910);影响其运动发育的因素分别是机械通气时间(OR=1.150)、HIE(OR=0.387)、再次插管(OR=0.346)。结论机械通气时间、早期干预、母亲妊高症与NRF患儿智力发育有关;机械通气时间、HIE、再次插管与其运动发育有关。

Objective To investigate the risk factors for the intelligence and development retardation of survivals in application of mechanical ventilation for the treatment of respiratory failure in neonatal intensive care unit( NICU). Methods The clinical data of 193 cases of infants in NICU who were treated with endotracheal intubation mechanical ventilation were retrospectively analyzed. The relationships of various factors during hospitalization which included maternal complications and perinatal conditions etc. with the intelligence and development retardation were observed. Early intervention guidance and follow-up were conducted on the survived,and they were tested for intelligence development at the age of 18 months in order to understand the development of neural development. Results In 436 cases of infants,193 children were followed up until the age of 18 months after discharge. The follow-up rate was 69. 17%. There were 16 cases of mental abnormality( 8. 29%),36 cases of abnormal movement( 18. 65%),13 cases were confirmed cerebral palsy( 6. 74%); and13 cases were confirmed the mental abnormalities accompanied with cerebral palsy( 16. 06%). Through the single factor analysis of risk factors,we found that gestational age ≥37 weeks,the time of endotracheal intubation ≥ 4 days and hypoxic ischemic encephalopathy( HIE) would affect the intellectual development( all P < 0. 05). Gestational age < 37 weeks,intracranial hemorrhage and re-intubation had effect on the motor function( all P < 0. 05). Significant difference was found between the children who received early intervention and chilled without early intervention( all P < 0. 001). Multivariable Logistic regression analysis showed that the factors which influenced the mental development were duration of ventilation( OR = 1. 183),early intervention( OR = 0. 301) and gestational hypertension( OR = 1. 910),respectively; the factors which influenced the motor function were duration of ventilation( OR = 1. 150),HIE( OR = 0. 387) and endotracheal reintubation( OR = 0. 346),respectively. Conclusions The neonates who need early application of mechanical ventilation are the high risk group of neuro-disability in NICU. The factors that affect the development of the intelligence are the ventilation time,the early intervention and pregnancy induced hypertension. The factors that affect the development of the sports are the ventilation time,HIE and re-intubation.