【作者】 林霞；

【导师】 孙正芸；

【作者基本信息】 山东大学 ， 儿科学， 2011， 硕士

【摘要】 研究背景及目的近年来,随着围产医学的发展、表面活性物质及静脉营养的应用,早产儿的存活率大大提高。但是,随之出现的一系列并发症及各系统后遗症成为目前困扰大家的主要问题。本课题通过回顾性分析在本院新生儿科住院早产儿的临床资料,旨在了解我院住院新生儿中早产儿的构成比、早产相关的危险因素、早产儿的常见并发症、预后相关因素等情况,为减少早产的发生、改善早产儿的生存质量提供流行病学依据。研究方法设计《省立医院新生儿科住院早产儿调查表》,采集自2008年1月至2010年6月于山东省立医院新生儿科住院的早产儿的临床资料,分析早产儿的并发症、危险因素及预后相关因素。应用SPSS17.0软件包对数据进行处理,以P<0.05有统计学意义。结果从2008年1月至2010年6月我院新生儿科共收治早产儿746例(其中2008年323例,2009年225例,2010年198例),占同期住院新生儿的31.34%。其中,资料不全者68例,予以剔除。具体情况如下。1.本组早产儿中胎龄≤28周者29例(4.28%)；28～30周者64例(9.44%)；30～32周者152例(22.42%)；32～34周者244例(35.99%)；34～36周者189例(27.88%)。平均胎龄32.98±2.22周。2.本组早产儿出生体重<1000g者14例(2.07%)；1000g～1500g者123例(18.14%)；1500g～2000g者205例(30.24%)；2000g～2500g者230例(33.92%)；≥2500g者106例(15.63%)。平均出生体重为1996±560g(600g-4010g)。3.本资料中母亲孕期合并疾病前三位分别为：妊娠期高血压综合征256例(37.76%)；子宫异常57例(8.41%)；妊娠期糖尿病35例(5.16%)。4.胎儿因素中以胎膜早破(207例,发生率30.53%)、多胎(201例,发生率29.65%)、宫内窘迫(125例,发生率18.44%)为最多。5.羊水、脐带、胎盘异常的发生情况依次为：羊水异常115例(16.96%)、脐带异常97例(14.31%)、胎盘异常60例(8.85%)。6.本组早产儿中1分钟Apgar评分<8分者204例(30.09%),5分钟Apgar评分<8分者107例(15.78%),10分钟Apgar评分<8分者69例(10.18%)。7.本资料早产儿中共发生MODS 10例(1.47%),DIC 8例(1.18%),放弃治疗51例(7.52%),死亡29例(4.28%)。主要并发症依次为：早产儿缺氧缺血性脑病380例(56.05%)、新生儿肺炎316例(46.61%)、NRDS 228例(33.63%)、新生儿窒息200例(29.50%)、电解质紊乱151例(22.27%)、呼吸暂停139例(20.50%)、高胆红素血症132例(19.47%)、新生儿贫血119例(17.55%)、喂养不耐受100例(14.75%)、先天发育异常80例(11.80%)、甲状腺功能低下76例(11.21%)、脏器损伤64例(9.44%)、败血症47例(6.93%)、糖代谢异常40例(5.90%)、硬肿症40例(5.90%)等。NRDS、窒息、呼吸暂停、肺炎、肺出血、BPD、HIE、颅内出血、喂养不耐受、新生儿贫血、暂时性甲状腺功能减低与出生体重和胎龄均呈负相关(P均<0.01)；另外,败血症、硬肿症和先天发育异常与胎龄之间也呈负相关(P<0.05)。NRDS、肺炎、窒息、喂养不耐受、肺出血、颅内出血、心力衰竭、呼吸衰竭与预后呈负相关(P均<0.001)；宫内窘迫和暂时性甲状腺功能减低与预后也呈负相关(P<0.05)。8.出生体重和胎龄与住院时间及预后均呈负相关(P均<0.001)。结论1.住院新生儿中早产儿的构成比呈上升趋势。2.诸多因素可引起早产,母亲因素以妊娠高血压综合征、子宫异常、妊娠期糖尿病为最多见；胎儿因素以胎膜早破、多胎、宫内窘迫为主；羊水、脐带、胎盘因素以羊水污染、脐带绕颈、前置胎盘和胎盘早剥最多见。3.HIE、NRDS、窒息、新生儿肺炎、呼吸暂停、高胆红素血症、贫血、喂养不耐受、电解质紊乱、暂时性暂时性甲状腺功能减低等为早产儿最常见的并发症。4.与早产儿预后相关的因素有NRDS、肺炎、窒息、喂养不耐受、肺出血、颅内出血、心力衰竭、呼吸衰竭、宫内窘迫、暂时性暂时性甲状腺功能减低。5.出生体重、胎龄与并发症的发生及预后不良相关性显著,提示加强产前检查及孕期教育、避免早产的发生至关重要。更多还原

【Abstract】 ObjectiveIn recent years, the incidence of preterm infants has increased gradually, and because of the development of Perinatal Medicine, the use of pulmonary surfactant and intravenous nutrition, the survival rate of preterm infants has notably increased. But a series of complications and sequelae of all systems come to be the main problem which puzzled every pediatric doctor. This subject is to understand the constituent ratio of preterm infants, risk factors of preterm birth, common complications of preterm infants and prognosis relevant factors by analyzing the clinical data of preterm infants hospitalized in our hospital retrospectively, in order to provide epidemic evidence for reducing the incidence of preturm birth and improving quality of life of preturm infants.MethodsQuestionaire of preterm infant hospitalized in NICU of Shandong provincial hospital was designed. The clinical data of preterm infants hospitalized in NICU of Shandong provincial hospital from January of 2008 to June of 2010 were collected to analyze the complication and risk factors of preterm birth. All the data were analyzed by SPSS 17.0, P<0.05 means having statistic significance.Results746 cases of preterm infants were admitted into our NICU from January of 2008 to June of 2010(323 cases in 2008,225 cases in 2009,198 cases in 2010), accounting for 31.34% of neonates of the same term.68 cases were excluded for incomplete data. Specific circumstance as follows.1. Among the 678 cases of preterm infants,29 cases(4.28%) of them were born at gestational age less than 28 weeks; 64 cases(9.44%) were born at gestational age of 28 to 30 weeks; 152 cases(22.42%) were born at gestational age of 30-32 weeks; 244 cases(35.99%) were born at gestational age of 32-34 weeks; 189 cases(27.88%) were born at gestational age of 34-36 weeks. The average gestational age was 32.98±2.22 weeks.2. Among the 678 cases of preterm infants, birth weight of 14 cases(2.07%) was below 1000g, birth weight of 123 cases(18.14%) was between 1000g to 1500g, birth weight of 205 cases(30.24%) was between 1500g to 2000g, birth weight of 230 cases(33.92%) was between 2000g to 2500g, birth weight of 106 cases(15.63%) was above 2500g. The average birth weight was 1996±560g (600g-401 Og)3.The age of their mothers differed from 20-year-old to 47-year-old. The most common maternal diseases were hypertension syndrome of pregnancy(37.76%), uterus abnormality(8.41%), gestational diabetes(5.16%).4. Fetal factors of preterm birth mainly included:preterm rupture of membrance 207 cases(30.53%), multiple births 201 cases(29.65%), fetal distress 125 cases(18.44%).5. The incidences of umbilical cord, amniotic fluid and placenta abnormality were 16.96%,14.31%,8.85%, respectively.6. Among all preterm infants in this study,204 cases(30.09%) had Apgar score less than 8 points in 1st minute after birth,107 cases (15.78%) had Apgar score less than 8 points in 5th minute after birth,69 cases (10.18%) had Apgar score less than 8 points in 10th minute after birth.7. Among all the 678 cases of preterm infants,10 cases(1.47%) had MODS,8 cases(1.18%) had DIC,51 cases(7.52%) were given up,29 cases (4.28%)died. The main complications successively were:HIE(56.05%), neonatal pneumonia(46.61%), NRDS(33.63%), asphyxia neonatorum(29.50%), electrolyte disturbance(22.27%), apnea(20.50%), hyperbilirubinemia(19.47%), anemia(17.55%), feeding intolerance(14.75%), congenital abnormal development 11.80%), transient hypothyroidism(11.21%), organ damage(9.44%), septemia(6.93%), abnormal glucose metabolism(5.90%), scleredema(5.90%). NRDS, asphyxia neonatorum, apnea, neonatal pneumonia, pulmonary hemorrhage, BPD, HIE, ICH, feeding intolerance, anemia and transient hypothyroidism had negative correlation with birth weight and gestational age (P all<0.01).In addition, septemia, scleredema and congenital abnormal development had negative correlation with gestational age (P<0.05). NRDS, neonatal pneumonia, asphyxia neonatorum, feeding intolerance, pulmonary hemorrhage, ICH, cardiac failure and respiratory failure had negative correlation with prognosis (P all<0.001). Fetal distress and transient hypothyroidism also had negative correlation with prognosis (P<0.05)8. Both birth weight and gestational age had negative correlation with hospital stays and prognosis (P all<0.001)Conclusion1. The constituent ratio of preterm infants in hospitalized neonates is on the rise.2. Many factors could lead to preterm birth. Hypertension syndrome of pregnancy, uterus abnormality and gestational diabetes were the most common maternal factors. Preterm rupture of membrance, multiple birth and fetal distress were the main fetal factors. Contaminate amniotic fluid, cord around neck. placental presentation placental abruption were the most common amniotic fluid, umbilical cord and placenta factors.3.The main complications of preturm infants included HIE, NRDS, asphyxia neonatorum, neonatal pneumonia, apnea, hyperbilirubinemia, anemia, feeding intolerance, electrolyte disturbance and transient hypothyroidism.4. NRDS, neonatal pneumonia, asphyxia neonatorum, feeding intolerance, pulmonary hemorrhage, ICH, cardiac failure, respiratory failure, fetal distress and transient hypothyroidism are related with prognosis.5. Birth weight and gestational age had notable correlation with bad prognosis, indicating that strengthening antenatal examination and pregnancy education, reducing the incidence of preterm birth are of great importance.更多还原