婴儿,超低出生体重%存活率%死亡率%回顾性研究
嬰兒,超低齣生體重%存活率%死亡率%迴顧性研究
영인,초저출생체중%존활솔%사망솔%회고성연구
Infant,extremely low birth weight%Survival rate%Mortality%Retrospective studies
目的 分析超低出生体重儿(ELBWI)的临床特点及转归.方法 对湖南省儿童医院2008年8月1日至2013年11月30日收治的165例ELBWI的临床资料进行回顾性分析,总结患儿一般资料及出生情况、产前及产房处理、转运情况、合并症、治疗及随访情况,按照出生体重、胎龄、入院时间进行分组,比较不同组别间转归情况.结果 (1)165例ELBWI胎龄(28.4±2.4)周,出生体重(910.9±93.1)g.(2)三级医院分娩率46.7％(77/165),产前使用地塞米松86例(52.1％,86/165),无在产房使用无创正压通气(CPAP)的病例.(3)出生后12h内转运至Ⅲ级b等新生儿病房的有97例(58.8％,97/165).(4)院内主要合并症有新生儿呼吸窘迫综合征(NRDS,77.0％,127/165)、支气管肺发育不良(BPD,70.1％,75/107)、动脉导管未闭(PDA,50.0％,40/80)、早产儿视网膜病变(ROP,43.0％,46/107)、败血症(39.4％,65/165)、脑室内出血(IVH,34.8％,49/141)、坏死性小肠结肠炎(NEC,8.0％,7/88).(5)治疗措施:97.6％ (161/165)接受氧疗,66.1％ (109/165)接受机械通气,55.2％ (91/165)使用了CPAP.89.8％(114/127)的NRDS使用了肺泡表面活性物质(PS),44.0％(33/75)的BPD使用了小剂量地塞米松,32.0％(24/75)的BPD使用了小剂量一氧化氮.60.0％ (24/40) PDA使用了药物治疗.32.6％ (15/46) ROP接受了激光光凝术.开奶时间2.0(1.1,9.2)d,达足量胃肠内喂养时间(43.4 ±21.9)d,21.2％(35/165)给予母乳喂养.(6)转归:165例ELBWI救治存活率51.5％(85/165),放弃治疗率37.6％(62/165),病死率48.5％(80/165).不同出生体重组、胎龄组、入院时间组间存活率比较差异均有统计学意义(x2=11.498、8.789、13.157,P均＜0.05);不同体重组、入院时间组放弃治疗率比较差异均有统计学意义(x2=10.448、8.259,P均＜0.05).(7)随访:部分随访的ELBWI患儿神经发育损害发生率27.9％(12/43).结论 ELBWI的合并症多,治疗复杂,住院时间长.应提高产前激素使用率,及时合理地进行宫内及出生后转运.
目的 分析超低齣生體重兒(ELBWI)的臨床特點及轉歸.方法 對湖南省兒童醫院2008年8月1日至2013年11月30日收治的165例ELBWI的臨床資料進行迴顧性分析,總結患兒一般資料及齣生情況、產前及產房處理、轉運情況、閤併癥、治療及隨訪情況,按照齣生體重、胎齡、入院時間進行分組,比較不同組彆間轉歸情況.結果 (1)165例ELBWI胎齡(28.4±2.4)週,齣生體重(910.9±93.1)g.(2)三級醫院分娩率46.7％(77/165),產前使用地塞米鬆86例(52.1％,86/165),無在產房使用無創正壓通氣(CPAP)的病例.(3)齣生後12h內轉運至Ⅲ級b等新生兒病房的有97例(58.8％,97/165).(4)院內主要閤併癥有新生兒呼吸窘迫綜閤徵(NRDS,77.0％,127/165)、支氣管肺髮育不良(BPD,70.1％,75/107)、動脈導管未閉(PDA,50.0％,40/80)、早產兒視網膜病變(ROP,43.0％,46/107)、敗血癥(39.4％,65/165)、腦室內齣血(IVH,34.8％,49/141)、壞死性小腸結腸炎(NEC,8.0％,7/88).(5)治療措施:97.6％ (161/165)接受氧療,66.1％ (109/165)接受機械通氣,55.2％ (91/165)使用瞭CPAP.89.8％(114/127)的NRDS使用瞭肺泡錶麵活性物質(PS),44.0％(33/75)的BPD使用瞭小劑量地塞米鬆,32.0％(24/75)的BPD使用瞭小劑量一氧化氮.60.0％ (24/40) PDA使用瞭藥物治療.32.6％ (15/46) ROP接受瞭激光光凝術.開奶時間2.0(1.1,9.2)d,達足量胃腸內餵養時間(43.4 ±21.9)d,21.2％(35/165)給予母乳餵養.(6)轉歸:165例ELBWI救治存活率51.5％(85/165),放棄治療率37.6％(62/165),病死率48.5％(80/165).不同齣生體重組、胎齡組、入院時間組間存活率比較差異均有統計學意義(x2=11.498、8.789、13.157,P均＜0.05);不同體重組、入院時間組放棄治療率比較差異均有統計學意義(x2=10.448、8.259,P均＜0.05).(7)隨訪:部分隨訪的ELBWI患兒神經髮育損害髮生率27.9％(12/43).結論 ELBWI的閤併癥多,治療複雜,住院時間長.應提高產前激素使用率,及時閤理地進行宮內及齣生後轉運.
목적 분석초저출생체중인(ELBWI)적림상특점급전귀.방법 대호남성인동의원2008년8월1일지2013년11월30일수치적165례ELBWI적림상자료진행회고성분석,총결환인일반자료급출생정황、산전급산방처리、전운정황、합병증、치료급수방정황,안조출생체중、태령、입원시간진행분조,비교불동조별간전귀정황.결과 (1)165례ELBWI태령(28.4±2.4)주,출생체중(910.9±93.1)g.(2)삼급의원분면솔46.7％(77/165),산전사용지새미송86례(52.1％,86/165),무재산방사용무창정압통기(CPAP)적병례.(3)출생후12h내전운지Ⅲ급b등신생인병방적유97례(58.8％,97/165).(4)원내주요합병증유신생인호흡군박종합정(NRDS,77.0％,127/165)、지기관폐발육불량(BPD,70.1％,75/107)、동맥도관미폐(PDA,50.0％,40/80)、조산인시망막병변(ROP,43.0％,46/107)、패혈증(39.4％,65/165)、뇌실내출혈(IVH,34.8％,49/141)、배사성소장결장염(NEC,8.0％,7/88).(5)치료조시:97.6％ (161/165)접수양료,66.1％ (109/165)접수궤계통기,55.2％ (91/165)사용료CPAP.89.8％(114/127)적NRDS사용료폐포표면활성물질(PS),44.0％(33/75)적BPD사용료소제량지새미송,32.0％(24/75)적BPD사용료소제량일양화담.60.0％ (24/40) PDA사용료약물치료.32.6％ (15/46) ROP접수료격광광응술.개내시간2.0(1.1,9.2)d,체족량위장내위양시간(43.4 ±21.9)d,21.2％(35/165)급여모유위양.(6)전귀:165례ELBWI구치존활솔51.5％(85/165),방기치료솔37.6％(62/165),병사솔48.5％(80/165).불동출생체중조、태령조、입원시간조간존활솔비교차이균유통계학의의(x2=11.498、8.789、13.157,P균＜0.05);불동체중조、입원시간조방기치료솔비교차이균유통계학의의(x2=10.448、8.259,P균＜0.05).(7)수방:부분수방적ELBWI환인신경발육손해발생솔27.9％(12/43).결론 ELBWI적합병증다,치료복잡,주원시간장.응제고산전격소사용솔,급시합리지진행궁내급출생후전운.
Objective To analyze the clinical features and prognosis of extremely low birth weight infants (ELBWI).Method Data of totally 165 hospitalized ELBWI between August 1st,2008 and November 30th,2013 in Hunan Children's Hospital were analyzed.The information of general data and births,prenatal care,delivery room stabilization,transfer information,complications,treatment,outcome and follow up were summarized.Result (1) One hundred and sixty-five ELBWI were involved,their mean gestational age was(28.4 ± 2.4) weeks,mean birth weight (910.9 ± 93.1) g.(2) Rate of delivery in tertiary hospital was 46.7％ (77/165)and prenatal steroids exposure was found in 52.1％ (86/165).None of the cases were treated with continuous positive airway pressure (CPAP) in delivery room.(3) Rate of infants who were transfered to the class Ⅲ b neonatal ward within 12 hours after birth was 58.8％ (97/165).(4) The main complications of them included neonatal respiratory distress syndrome (NRDS,77.0％,127/165),bronchopulmonary dysplasia (BPD,70.1％,75/107),patent ductus arteriosus (PDA,50.0％,40/80),preterm retinopathy (ROP,43.0％,46/107),sepsis 39.4％ (65/165),intraventricular hemorrhage (IVH,34.8％,49/141),necrotizing enterocolitis(NEC,8.0％,7/88).(5) Treatment:97.6％(161/165) received oxygen therapy and 66.1％ (109/165) received mechanical ventilation,55.2％ (91/165) used CPAP.89.8％ (114/127) of the NRDS used PS; 44.0％ (33/75) of the BPD used low dose dexamethasone,32.0％ (24/75) used low dose nitric oxide; 60.0％ (24/40)of the PDA used medication.32.6％ (15/46) of the ROP received laser photocoagulation.The average time of beginning enteral feeding was 2.0 d,the mean time to achieve full gastrointestinal feeding was 43.4 d.(6) Outcome:rate of survival in 165 cases with ELBWI was 51.5％ (85/165),treatment was abandoned in 37.6％ (62/165),total mortality was 48.5％ (80/165).There were significant difference in survival rate between different birth weight group,gestational age group and admission age group(x2 =11.498,8.789,13.157,all P ＜ 0.05) ; There was significant difference in rate of giving up treatment between different birth weight and admission age groups (x2 =10.448,8.259,all P ＜ 0.05).The primary cause of death was economic factor and worrying about prognosis.(7) Follow up:rate of neurodevelopmental impairment(NDI) in part of follow up cases was 27.9％ (12/43).Conclusion ELBWI have many severe complications and sequelae,which need complex treatment and long hospital stay with a low survival rate.In order to improve the level of treatment,we need to improve the rate of prenatal steroids,carry out intrauterine and postnatal,transport of ELBWI to Ⅲ b neonatal ward as early and rationally as possible,give professional,sophisticated and integrated treatment technologies as far as possible.
