超未成熟儿的生存状况与预后影响因素分析

Analysis of survival and prognostic factors in extremely preterm infants

摘要:

目的 探讨胎龄28 周以下超未成熟儿在新生儿重症监护病房（NICU）的存活率、住院期间并发症发生情况及其预后。方法 收集2011 年1 月至2013 年3 月入住NICU 的胎龄<28 周早产儿90例，回顾性分析围产期资料、出生及复苏史、住院期间通气/ 氧疗情况，以及严重脑室内出血（IVH）、支气管肺发育不良（BPD）、早产儿视网膜病（ROP）、动脉导管未闭（PDA）、败血症等的发生率。结果 90 例患儿平均胎龄26±1 周，出生体重898±165 g，总存活率为57%，病死率9%，放弃率34%。常见并发症包括新生儿呼吸窘迫综合征（RDS）88%、BPD 85%、PDA 69%， ROP 68%，Ⅲ、Ⅳ级IVH 31%；存活早产儿平均住院时间为83±18 d，出院平均体重为2419±300 g。多因素logistic 回归分析发现，肺出血与严重IVH 为死亡或放弃的高危因素，产前使用糖皮质激素为保护因素。结论 目前国内超未成熟儿存活率相比发达国家仍有较大差距；肺出血、严重IVH 为影响预后的重要因素。

Abstract:

Objective To investigate the survival rate, complications during hospitalization, and prognostic factors in extremely preterm infants (gestational age less than 28 weeks) in the neonatal intensive care unit (NICU). Methods A retrospective analysis was performed on 90 extremely preterm infants who were admitted to the NICU between January 2011 and March 2013 to investigate the perinatal data, delivery and resuscitation, ventilation/ oxygen supply during hospitalization, mortality, and the incidence of severe (grade III/IV) intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), patent ductus arteriosus (PDA), and septicemia. Results Among the 90 extremely preterm infants, the gestational age, birth weight, overall survival rate, mortality, and withdrawal rate were 26±1 weeks, 898±165 g, 57%, 9%, and 34%, respectively. The incidence rates of neonatal respiratory distress syndrome, BPD, PDA, ROP, and grade III/IV IVH were 88%, 85%, 69%, 68%, and 31%, respectively. The surviving infants had a mean length of hospital stay of 83±18 days and a mean weight at discharge of 2419±300 g. The multivariate logistic regression analysis showed that grade III/IV IVH and pulmonary hemorrhage were high-risk factors for death or withdrawal, while antenatal corticosteroids were the protective factor for outcome (P<0.05). Conclusions The survival rate of extremely preterm infants is still much lower than that in developed countries. grade III/IV IVH, and pulmonary hemorrhage are important prognostic factors.