需要机械通气的极低出生体重儿院内病死率及病死风险因素的前瞻性研究

Prospective study on in-hospital mortality and its risk factors in very low birth weight infants requring mechanical ventilation

摘要:

目的：描述危重极低出生体重儿（VLBWI）的临床特征、接受治疗状况及其转归，评估其病死风险相关因素，评价CRIB、SNAPPE-II评分系统预测我国早产儿病死风险的价值。方法：对2010年1月至2011年10月间新生儿重症监护室（NICU）收治的127例需要机械通气的VLBWI进行前瞻性数据收集。结果：纳入患儿平均胎龄为31±2 周，平均体重为1290±170 g，男女比例为1.23∶1，超低出生体重儿占6.3%。接受肺表面活性剂（PS）治疗者占 48.0%；接受气管插管机械通气的患儿占49.6%。总的院内病死率为41.7%。低出生体重、多胎分娩、剖宫产、低PaO2/FiO2比值是病死的独立风险因素，OR值分别为1.611、7.572、4.062、0.133，P<0.05。SNAPPE-II和CRIB评分系统可较好地预测病死转归，ROC曲线下面积分别为0.806、0.777。结论：VLBWI总的病死率仍处于较高水平；低出生体重、多胎分娩、剖宫产、低PaO2/FiO2比值是VLBWI病死的高危因素。应用新生儿危重评分系统可对研究对象疾病危重程度进行量化。

Abstract:

OBJECTIVE: To describe the clinical features, treatments and prognosis of very low birth weight infants (VLBWIs) requring mechanical ventilation, to assess the risk factors associated with the mortality of VLBWIs, and to evaluate the significance of the scoring system based on clinical risk index for babies (CRIB) and the score for neonatal acute physiology-perinatal extension II (SNAPPE-II) for predicting mortality risk for premature infants in China. METHODS: Perinatal data were collected from 127 VLBWIs requring mechanical ventilation who were admitted to the neonatal intensive care unit (NICU) from January 2010 to October 2011. RESULTS: The enrolled infants had a mean gestational age of 31±2 weeks, a mean birth weight of 1290±170 g, a male/female ratio of 1.23∶1, and extremely low birth weight infant accounting for 6.3%. Of the 127 cases, 48.0% were administered with pulmonary surfactant (PS), and 49.6% received endotracheal intubation ventilation. The overall in-hospital mortality was 41.7%. Multivariate logistic regression revealed the following independent risk factors for mortality: low birth weight, multiple birth, cesarean section, and low PaO2/FiO2 ratio (OR = 1.611, 7.572, 4.062, and 0.133 respectively; P<0.05). SNAPPE-II and CRIB showed good performance in predicting prognosis, with areas under the ROC curve of 0.806 and 0.777 respectively. CONCLUSIONS: The overall mortality rate of VLBWIs is still relatively high. The high-risk factors for VLBWI mortality include low birth weight, multiple birth, cesarean section, and low PaO2/FiO2 ratio. The neonatal illness severity scoring system (using SNAPPE-II and CRIB) can be used to quantify illness severity in premature infants.