极低及超低出生体重儿的预后因素分析

Prognostic factors in very low birth weight infants and extremely low birth weight infants

摘要:

目的 分析极低及超低出生体重儿（出生体重≤ 1 200 g）的临床资料，为其预后及临床干预提供预警指标。方法 回顾性分析108 例极低及超低出生体重儿的母孕期病史、新生儿出生时情况、诊治经过及预后，采用非条件logistic 回归分析筛选预后的影响因素。结果 108 例极低及超低出生体重儿，出生体重范围在<800 g，800~999 g 和1000~1200 g 的早产儿分别为15 例、29 例和64 例。存活72 例，死亡36 例，病死率为33.3%。前置胎盘、5 分钟 Apgar ≤ 3 分是导致这些早产儿出生24 h 内死亡的主要危险因素；胎膜早破、5 分钟 Apgar ≤ 3 分及肺出血是生后24 h 至7 d 内死亡的危险因素；出生7 d 后死亡的独立危险因素是侵袭性真菌感染导致的晚发型败血症，妊高征是这个阶段早产儿死亡的保护因素。结论 极低及超低出生体重儿的病死率较高，且随着日龄的增加，影响早产儿生存的预后因素不同，临床上应针对这些因素制定合理的管理方案，提高早产儿生存率。

Abstract:

Objective To analyze the clinical data of very low birth weight infants (VLBWIs) and extremely low birth weight infants (ELBWIs) (birth weight ≤1 200 g) and to provide prewarning indicators for prognostic evaluation and clinical intervention. Methods A retrospective analysis was performed on the clinical data of 108 VLBWIs and ELBWIs to investigate the maternal history of diseases during pregnancy, neonatal birth status, the process of diagnosis and treatment, and prognosis. Unconditional logistic regression analysis was used to determine prognostic factors. Results Of the 108 preterm infants, 15 had a birth weight of <800 g, 29 had a birth weight of 800-999 g, and 64 had a birth weight of 1000-1200 g. The mortality was 33.3% (36/108). Placenta previa and Apgar score ≤3 at 5 minutes were the main risk factors for death within 24 hours of birth; premature rupture of membrane, Apgar score ≤3 at 5 minutes, and pulmonary hemorrhage were the main risk factors for death between 24 hours and 7 days after birth; late-onset sepsis caused by invasive fungal infection was an independent risk factor for death over 7 days after birth, while pregnancyinduced hypertension syndrome was a protective factor. Conclusions The mortality in VLBWIs and ELBWIs is relatively high, and the prognostic factors vary between preterm infants of different ages. Clinicians should discuss management options for the infants on the basis of these findings to increase the survival of preterm infants.