Objective To investigate the factors in relation with the case fatality in severe meconium aspiration syndrome (MAS). Methods Eighty-one severe MAS cases intervened by the mechanical ventilation from 9 childrens hospi...Objective To investigate the factors in relation with the case fatality in severe meconium aspiration syndrome (MAS). Methods Eighty-one severe MAS cases intervened by the mechanical ventilation from 9 childrens hospitals were retrospectively analyzed for the risk factors of fatality with SAS software for non-parametric rank sum test and chi-square test. Results In the 81 cases, 49 were survived (death rate 39%). The gestational age (GA), Apgars score at 1min and other complications with MAS were significantly related to the death (P <0.05). There was no difference of death rate between the patients with or without receiving endotracheal intubation and airway suctioning (P>0.05). Conclusion A higher death rate (close to 40%) of severe MAS in the middle of 1990s in major cities of China suggests that it is important to detect the intrauterine hypoxemia as it may indicated by meconium staining amniotic fluid which should be intervened early by adequate termination of pregnancy before 42 weeks. The effects of delivery room suction and conventional ventilation also need to be reevaluated.展开更多
目的:分析胎粪污染羊水(MSAF)新生儿发生胎粪吸入综合征(MAS)的风险评估简表构建及预测效果。方法:收集2023年1月至2023年12月江西信丰县妇幼保健院收治的MSAF新生儿60例为研究对象,根据是否并发MAS分无MAS组、MAS组,回顾性收集两组患...目的:分析胎粪污染羊水(MSAF)新生儿发生胎粪吸入综合征(MAS)的风险评估简表构建及预测效果。方法:收集2023年1月至2023年12月江西信丰县妇幼保健院收治的MSAF新生儿60例为研究对象,根据是否并发MAS分无MAS组、MAS组,回顾性收集两组患儿一般资料、实验室检查指标、母亲一般资料等进行分析。应用多因素Logistic回归分析MSAF新生儿发生MAS的危险因素,基于危险因素构建MSAF新生儿发生MAS的风险评估简表,并采用受试者特征曲线(ROC)验证该风险评估简表的预测效果。结果:本研究共纳入60例MSAF新生儿,发生MAS的患儿21例(35.00%);MAS组1 min阿普加(Apgar)评分、胎膜早破发生率、羊水过少、外周血白细胞(WBC)、降钙素原(PCT)较无MAS组明显高(P<0.05);MAS组酸碱值(pH值)、碱剩余(BE值)较无MAS组明显低(P<0.05)。经多因素Logistic回归分析示,羊水过少、pH值、WBC及1 min Apgar评分(4个)是MSAF新生儿发生MAS的独立危险因素(P<0.05)。依据Logistic回归分析结果构建胎粪污染羊水新生儿发生MAS的风险评估简表,ROC分析显示其预测MAS的曲线下面积为0.955(95%CI:0.920~0.974),敏感性为85.71%,特异性为92.31%。结论:MSAF新生儿发生MAS的独立危险因素有羊水过少、pH值、WBC及1 min Apgar评分,以此构建风险评估简表模型,预测效果显著。展开更多
目的:探讨足月新生儿发生胎粪吸入综合征(MAS)的影响因素并构建预测模型。方法:回顾性分析2018年3月至2021年5月产检发现有胎粪污染羊水的507例足月儿及其母亲资料,按照新生儿出生3 d内是否发生MAS,分为MAS组和非MAS组,比较2组相关指标...目的:探讨足月新生儿发生胎粪吸入综合征(MAS)的影响因素并构建预测模型。方法:回顾性分析2018年3月至2021年5月产检发现有胎粪污染羊水的507例足月儿及其母亲资料,按照新生儿出生3 d内是否发生MAS,分为MAS组和非MAS组,比较2组相关指标,并进行多因素logistic回归分析,建立预测模型,采用ROC曲线分析模型区分度,采用拟合优度检验模型校准度,并选取2021年7月至2022年3月产检发现有胎粪污染羊水的184例足月儿作为模型的临床验证。结果:507例胎粪污染羊水的足月儿发生MAS共62例(12.23%)。胎儿窘迫、分娩孕周、分娩方式、羊水污染、新生儿脐血pH值、新生儿1 min Apgar评分均为足月新生儿发生MAS的独立影响因素(P<0.05~P<0.01)。构建得出预测模型方程为:Logit(P)=0.704×胎儿窘迫(0=否;1=是)+0.625×分娩孕周(实测值)+0.443×分娩方式(0=顺产;1=剖宫产)+1.267×羊水污染分度(0=Ⅰ度;1=Ⅱ度;2=Ⅲ度)+0.694×新生儿脐血pH值(实测值)+0.783×新生儿1 min Apgar评分(实测值)-27.894。该模型的ROC曲线下面积为0.877(95%CI:0.828~0.927),最大约登指数(0.736)对应的灵敏度和特异度分别为88.70%和84.60%。拟合优度检验显示χ2=1.13,P>0.05,表明模型不存在过拟合现象。经临床验证,模型灵敏度为87.50%,特异度为85.63%,准确率为85.87%。结论:足月妊娠产妇所娩新生儿MAS的影响因素有胎儿窘迫、分娩孕周、剖宫产、羊水污染、新生儿脐血pH值、新生儿1 min Apgar评分,以此构建预测模型,区分良好,预测效能高。展开更多
文摘Objective To investigate the factors in relation with the case fatality in severe meconium aspiration syndrome (MAS). Methods Eighty-one severe MAS cases intervened by the mechanical ventilation from 9 childrens hospitals were retrospectively analyzed for the risk factors of fatality with SAS software for non-parametric rank sum test and chi-square test. Results In the 81 cases, 49 were survived (death rate 39%). The gestational age (GA), Apgars score at 1min and other complications with MAS were significantly related to the death (P <0.05). There was no difference of death rate between the patients with or without receiving endotracheal intubation and airway suctioning (P>0.05). Conclusion A higher death rate (close to 40%) of severe MAS in the middle of 1990s in major cities of China suggests that it is important to detect the intrauterine hypoxemia as it may indicated by meconium staining amniotic fluid which should be intervened early by adequate termination of pregnancy before 42 weeks. The effects of delivery room suction and conventional ventilation also need to be reevaluated.
文摘目的:分析胎粪污染羊水(MSAF)新生儿发生胎粪吸入综合征(MAS)的风险评估简表构建及预测效果。方法:收集2023年1月至2023年12月江西信丰县妇幼保健院收治的MSAF新生儿60例为研究对象,根据是否并发MAS分无MAS组、MAS组,回顾性收集两组患儿一般资料、实验室检查指标、母亲一般资料等进行分析。应用多因素Logistic回归分析MSAF新生儿发生MAS的危险因素,基于危险因素构建MSAF新生儿发生MAS的风险评估简表,并采用受试者特征曲线(ROC)验证该风险评估简表的预测效果。结果:本研究共纳入60例MSAF新生儿,发生MAS的患儿21例(35.00%);MAS组1 min阿普加(Apgar)评分、胎膜早破发生率、羊水过少、外周血白细胞(WBC)、降钙素原(PCT)较无MAS组明显高(P<0.05);MAS组酸碱值(pH值)、碱剩余(BE值)较无MAS组明显低(P<0.05)。经多因素Logistic回归分析示,羊水过少、pH值、WBC及1 min Apgar评分(4个)是MSAF新生儿发生MAS的独立危险因素(P<0.05)。依据Logistic回归分析结果构建胎粪污染羊水新生儿发生MAS的风险评估简表,ROC分析显示其预测MAS的曲线下面积为0.955(95%CI:0.920~0.974),敏感性为85.71%,特异性为92.31%。结论:MSAF新生儿发生MAS的独立危险因素有羊水过少、pH值、WBC及1 min Apgar评分,以此构建风险评估简表模型,预测效果显著。
文摘目的:探讨足月新生儿发生胎粪吸入综合征(MAS)的影响因素并构建预测模型。方法:回顾性分析2018年3月至2021年5月产检发现有胎粪污染羊水的507例足月儿及其母亲资料,按照新生儿出生3 d内是否发生MAS,分为MAS组和非MAS组,比较2组相关指标,并进行多因素logistic回归分析,建立预测模型,采用ROC曲线分析模型区分度,采用拟合优度检验模型校准度,并选取2021年7月至2022年3月产检发现有胎粪污染羊水的184例足月儿作为模型的临床验证。结果:507例胎粪污染羊水的足月儿发生MAS共62例(12.23%)。胎儿窘迫、分娩孕周、分娩方式、羊水污染、新生儿脐血pH值、新生儿1 min Apgar评分均为足月新生儿发生MAS的独立影响因素(P<0.05~P<0.01)。构建得出预测模型方程为:Logit(P)=0.704×胎儿窘迫(0=否;1=是)+0.625×分娩孕周(实测值)+0.443×分娩方式(0=顺产;1=剖宫产)+1.267×羊水污染分度(0=Ⅰ度;1=Ⅱ度;2=Ⅲ度)+0.694×新生儿脐血pH值(实测值)+0.783×新生儿1 min Apgar评分(实测值)-27.894。该模型的ROC曲线下面积为0.877(95%CI:0.828~0.927),最大约登指数(0.736)对应的灵敏度和特异度分别为88.70%和84.60%。拟合优度检验显示χ2=1.13,P>0.05,表明模型不存在过拟合现象。经临床验证,模型灵敏度为87.50%,特异度为85.63%,准确率为85.87%。结论:足月妊娠产妇所娩新生儿MAS的影响因素有胎儿窘迫、分娩孕周、剖宫产、羊水污染、新生儿脐血pH值、新生儿1 min Apgar评分,以此构建预测模型,区分良好,预测效能高。