新生儿窒息与多脏器功能障碍综合征的临床关系分析

Relationship between Neonatal Asphyxia and the Multiple Organ Dysfunction yndrome

摘要:

目的  探讨新生儿窒息后多脏器功能障碍综合征（ＭＯＤＳ）的发生率、病死率及其与窒息程度、胎龄、出生体重的关系。方法  对１００例新生儿窒息进行前瞻性研究，观察轻、重度窒息组ＭＯＤＳ及单器官损害的发生率和病死率，以及围产因素与ＭＯＤＳ的关系。结果  重度窒息组ＭＯＤＳ的发生率为７１．４％，高于轻度窒息组（３０．８％）（χ２＝１５．２０，Ｐ＜ ０．０１）；重度窒息组脑、肺、心血管、肾、胃肠损害发生率分别为９１．４％，７７．１％，５４．３％，３４．３％，２２．９％，轻度窒息组分别为３８．５％，３３．８％，２０．０％，１２．３％，７．７％，差异均有显著性（Ｐ＜００１或 ０．０５），重度窒息组病死率（２２．９％）高于轻度窒息组（６．２％）（χ２＝６．０１，Ｐ＜０．０５）。窒息患儿中早产儿、低出生体重儿ＭＯＤＳ的发生率及病死率较足月儿、正常体重儿高，差异有显著性（Ｐ＜０．０５）。结论  重视围产期保健，降低早产儿、低出生体重儿的发生率，防止新生儿窒息，是减少ＭＯＤＳ的关键。

Abstract:

OBJECTIVE: To study the relationship between the incidence and mortalit y of the multiple organ dysfunction syndrome(MODS) following asphyxia and the seve rity of asphyxia, pregnant age and birth weight in neonates. METHODS: A prospective study was done in 100 neonates with asphyxia. RESULTS: The incidence of MODS in the severe asphyxia neonates(severe group)(71.4%) was much higher than that in the mild asphyxia neonates(mild group)(30.8%)(P < 0.01); th e incidence of brai n, lung , cardiovascular system, kidney and gastroenteric damage in the severe group was 91.4 %,77.1 %, 54.3 %, 34.3 % and 22.9 % ,respectively. It differed signi ficantly fro m that in the mild group(38.5%, 33.8%, 20.0%,12.3% and 7.7%,respectively) (P <0.01 or 0.05).Ho wever, there was no significant difference in the incidence of liver damage bet ween the two groups.The mortality in the severe group(22.9%) wa s much highe r than that in the mild group(6.2%)(P < 0.05).There was a close correlat ion bet ween the incidence and mortality of MODS and the pregnant age and birth weight; the incidence and mortality of MODS in premature neonates and low birth weight neonates were higher than those in full?term neonates and normal birth weight ne onates(P < 0.05). CONCLUSIONS: The key issue of reducing the incidence of MOD S following asphyxia is to improve perinatal care and reduce the incidence of pr eterm birt h and low birth weight neonates. It is also necessary to take measur es to prevent asphyxia in neonates.