呼吸衰竭新生儿放弃治疗的影响因素分析

Contributing factors for the withdrawal from treatment in neonates with respiratory failure

摘要:

目的 探讨呼吸衰竭新生儿放弃治疗的影响因素。方法 回顾性收集2019年1~12月江苏省30家医院报告的2 525例新生儿呼吸衰竭病例的临床资料，根据是否积极治疗分为两组：积极治疗组（2 162例）和放弃治疗组（363例）。采用多因素logistic回归分析法探讨呼吸衰竭新生儿放弃治疗的影响因素。结果 多因素logistic回归分析显示，小于胎龄儿、先天性畸形、胎龄小于28周、居住在农村或县级市、母亲年龄小于25岁是呼吸衰竭新生儿放弃治疗的危险因素（均P < 0.05），而较高的5 min Apgar评分和剖宫产是保护因素（均P < 0.05）。在愿意告知放弃治疗直接原因的160名患儿家长中，共有176频次的答案，放弃治疗的直接原因依次是：存在严重后遗症（44.9%，79/176）、疾病无法控制（24.4%，43/176）、家庭经济困难（18.2%，32/176）和呼吸机依赖（12.5%，22/176）。结论 小于胎龄儿、先天性畸形、胎龄、居住地区、母亲年龄、出生后Apgar评分和出生方式是呼吸衰竭新生儿放弃治疗的影响因素。呼吸衰竭新生儿放弃治疗主要的直接原因是患儿可能的不良预后和今后的生命质量，但仍需进一步证实。

Abstract:

Objective To investigate the factors contributing to the withdrawal from treatment in neonates with respiratory failure. Methods The medical data of 2 525 neonates with respiratory failure were retrospectively studied, who were reported in 30 hospitals of Jiangsu Province from January to December, 2019. According to whether a complete treatment was given, they were divided into a complete treatment group with 2 162 neonates and a withdrawal group with 363 neonates. A multivariate logistic regression analysis was used to investigate the factors contributing to the withdrawal from treatment in neonates with respiratory failure. Results The multivariate logistic regression analysis showed that small-for-gestational-age birth, congenital abnormality, gestational age < 28 weeks, living in the rural area or county-level city, and maternal age < 25 years were risk factors for the withdrawal from treatment in neonates with respiratory failure (P < 0.05), while a higher 5-minute Apgar score and cesarean section were protective factors (P < 0.05). Furthermore, 176 answers were obtained from 160 parents of the neonates who were willing to tell the reason for the withdrawal from treatment, among which severe sequelae (44.9%, 79/176) had the highest frequency, followed by uncontrollable disease condition (24.4%, 43/176), family financial difficulties (18.2%, 32/176), and dependence on mechanical ventilation (12.5%, 22/176). Conclusions Small-for-gestational-age birth, congenital abnormality, gestational age, living area, maternal age, Apgar score at birth, and method of birth are contributing factors for the withdrawal from treatment in neonates with respiratory failure. A poor prognosis and a low quality of life in future might be major immediate causes of withdrawal from treatment in neonates with respiratory failure, which needs to be confirmed by further studies.