一所地市级医院NICU中新生儿肺出血的高危因素分析

Risk factors for neonatal pulmonary hemorrhage in the neonatal intensive care unit of a municipal hospital

摘要:

目的 探讨某地市级医院NICU中发生新生儿肺出血 （NPH）高危因素，为地市级医院救治NPH提供早期识别依据。方法 某地市级医院NICU确诊的112例NPH患儿作为病例组，按巢式病例配对法选取同期住院、予呼吸机辅助呼吸但未并发生肺出血的224例新生儿为对照组，采用单因素分析和非条件logistic回归分析法对NPH的高危因素进行统计学分析。结果 单因素分析结果显示：病例组母妊娠期糖尿病及胆汁淤积症，患儿剖腹产出生，胎龄 < 34周，5 min Apgar评分≤ 5分，体重 < 2 500 g，NPH前出现心力衰竭、弥漫性血管内凝血 （DIC）、PaO₂/FiO₂ （氧合指数，OI）≤100及平均血小板体积减小的发生比率明显高于对照组。Logistic回归多因素分析显示：DIC、心力衰竭、OI ≤ 100是NPH的独立危险因素 （OR分别为33.975、3.975、1.818；P < 0.05）。结论 心力衰竭、OI≤100、DIC是地市级医院NICU发生NPH高危因素，应针对这些因素开展积极的原发病治疗和病情监测。

Abstract:

Objective To investigate the risk factors for neonatal pulmonary hemorrhage (NPH) in the neonatal intensive care unit (NICU) of a municipal hospital, and to provide a basis for the early identification and treatment of NPH. Methods A total of 112 neonates who were admitted to the NICU of Shaoyang Central Hospital of Hunan Province and diagnosed with NPH were enrolled as the case group. A nested case-control method was used to select, as a control group (n=224), the neonates who underwent the treatment with an assisted mechanical ventilator and did not experience pulmonary hemorrhage. Univariate analysis and unconditional logistic regression analysis were used to identify the high risk factors for NPH. Results The univariate analysis showed that compared with the control group, the case group had significantly higher incidence rates of gestational diabetes and cholestasis in mothers, cesarean delivery, gestational age < 34 weeks, 5-minute Apgar score ≤ 5, birth weight < 2 500 g, heart failure and disseminated intravascular coagulation (DIC) before the development of NPH, partial pressure of oxygen/fraction of inspired oxygen (oxygenation index, OI) ≤ 100, and a reduction in mean platelet volume. The multivariate logistic regression analysis showed that DIC, heart failure, and OI ≤ 100 were independent risk factors for NPH (OR=33.975, 3.975, 1.818 respectively; P < 0.05). Conclusions Heart failure, OI ≤ 100, and DIC are risk factors for the development of NPH in the NICU of the municipal hospital.