2007-2016年极低和超低出生体质量儿921例临床回顾性分析
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摘要
目的:回顾性分析比较我院2007-2016年极低和超低出生体质量儿出生率与病死率的情况,探讨此类患儿的死亡原因,为降低其病死率提供参考。方法:通过病案室记录、出入院登记本查对并记录极低/超低出生体质量儿的基本信息,按时间分为前5年(2007-2011年)和后5年(2012-2016年)两组,统计其出生率、病死率、死亡原因。结果:本院2007年1月至2016年12月共分娩73 716例新生儿,其中极低/超低出生体质量儿921例。前5年的平均出生率、病死率分别为1. 50%(1. 04%～1. 72%)、31. 10%(27. 10%～47. 50%),后5年的平均出生率、病死率分别为1. 12%(1. 02%～1. 33%)、23. 68%(20. 00%～26. 41%),后5年与前5年比较出生率及病死率均明显下降,差异有统计学意义(P<0. 01)。<28周组、28～32周组、> 32周组极低/超低出生体质量儿总体死亡构成比分别为47. 89%、22. 09%、12. 54%,差异有统计学意义(P<0. 01),死亡前4位主要病因分别为新生儿呼吸窘迫综合征、重度窒息、新生儿畸形、新生儿肺出血。但市区和周边区县患儿死亡原因的具体构成比不同:市区患儿呼吸窘迫综合征、重度窒息、新生儿畸形、肺出血死亡构成比分别为52. 63%、23. 68%、6. 58%、5. 26%;周边区县患儿呼吸窘迫综合征、重度窒息、新生儿畸形、肺出血死亡构成比分别为60. 82%、28. 07%、9. 36%、7. 02%,虽然周边区县患儿呼吸窘迫综合征、重度窒息、新生儿畸形及肺出血的死亡构成比均高于市区,但差异无统计学意义(P>0. 05)。结论:我院2007-2016年极低/超低出生体质量儿的出生率及病死率均明显下降,死亡原因主要为呼吸窘迫综合征、重度窒息。临床应进一步提高新生儿复苏水平及肺表面活性剂产房内的及时应用,加强对周边区县地区孕期保健工作的宣教,提高孕期产前的依从性。
Objective: To retrospectively analyze and compare the fertility and mortality of very low/extremely low birth weight infants from Jan. 2007 to Dec. 2016,and to explore the causes of death and to provide reference for reducing the mortality. Methods: The basic information of the very low/extremely low birth weight infants was checked and recorded by the medical record room,all children were divided into the first 5 years(2007-2011) and the last 5 years(2012-2016) according to the time. Statistical analysis was conducted on the fertility,mortality and causes. Results: From Jan. 2007 to Dec. 2016,a total of 73,716 newborns were delivered,of which 921 were very low/extremely low birth weight. The average fertility and mortality in the first 5 years were 1. 50%(from 1. 04% to1. 72%) and 31. 10%(from 27. 10% to 47. 50%),respectively. The average fertility and mortality in the last 5 years were 1. 12%(from 1. 02% to 1. 33%) and 23. 68%(from 20. 00% to 26. 41%),the fertility and mortality decreased significantly in the last 5 years compared with the first 5 years,the difference was statistically significant(P< 0. 01). The overall mortality of very low/extremely low birth weight in the < 28-week group,28-32 week group and > 32-week group were 47. 89%,22. 09% and 12. 54%,respectively,with statistically significant differences(P < 0. 01). The four main causes of death were neonatal respiratory distress syndrome,severe asphyxia,neonatal malformation and neonatal pulmonary hemorrhage,respectively. However,the specific composition ratio of death causes of children in urban areas and surrounding districts and counties was different,the composition ratio of death causes of respiratory distress syndrome,severe suffocation,neonatal malformation,and pulmonary hemorrhage of children in urban areas was 52. 63%,23. 68%,6. 58%,and 5. 26%,respectively. The composition ratio of respiratory distress syndrome,severe asphyxia,neonatal malformation and pulmonary hemorrhage in the surrounding districts and counties were 60. 82%,28. 07%,9. 36%,and 7. 02%,respectively,although the mortality of above indicators of the surrounding districts and counties were higher than those of urban areas,the difference was not statistically significant(P>0. 05). Conclusion: From Jan. 2007 to Dec. 2016,the fertility and mortality of very low/extremely low birth weight infants decreased significantly,and the main causes of death were respiratory distress syndrome and severe asphyxia. In clinical practice,neonatal resuscitation level and timely application of pulmonary surfactant in the delivery room should be further improved,and publicity and education of prenatal health care in surrounding districts and counties should be strengthened so as to improve the prenatal compliance.
Objective: To retrospectively analyze and compare the fertility and mortality of very low/extremely low birth weight infants from Jan. 2007 to Dec. 2016,and to explore the causes of death and to provide reference for reducing the mortality. Methods: The basic information of the very low/extremely low birth weight infants was checked and recorded by the medical record room,all children were divided into the first 5 years(2007-2011) and the last 5 years(2012-2016) according to the time. Statistical analysis was conducted on the fertility,mortality and causes. Results: From Jan. 2007 to Dec. 2016,a total of 73,716 newborns were delivered,of which 921 were very low/extremely low birth weight. The average fertility and mortality in the first 5 years were 1. 50%(from 1. 04% to1. 72%) and 31. 10%(from 27. 10% to 47. 50%),respectively. The average fertility and mortality in the last 5 years were 1. 12%(from 1. 02% to 1. 33%) and 23. 68%(from 20. 00% to 26. 41%),the fertility and mortality decreased significantly in the last 5 years compared with the first 5 years,the difference was statistically significant(P< 0. 01). The overall mortality of very low/extremely low birth weight in the < 28-week group,28-32 week group and > 32-week group were 47. 89%,22. 09% and 12. 54%,respectively,with statistically significant differences(P < 0. 01). The four main causes of death were neonatal respiratory distress syndrome,severe asphyxia,neonatal malformation and neonatal pulmonary hemorrhage,respectively. However,the specific composition ratio of death causes of children in urban areas and surrounding districts and counties was different,the composition ratio of death causes of respiratory distress syndrome,severe suffocation,neonatal malformation,and pulmonary hemorrhage of children in urban areas was 52. 63%,23. 68%,6. 58%,and 5. 26%,respectively. The composition ratio of respiratory distress syndrome,severe asphyxia,neonatal malformation and pulmonary hemorrhage in the surrounding districts and counties were 60. 82%,28. 07%,9. 36%,and 7. 02%,respectively,although the mortality of above indicators of the surrounding districts and counties were higher than those of urban areas,the difference was not statistically significant(P>0. 05). Conclusion: From Jan. 2007 to Dec. 2016,the fertility and mortality of very low/extremely low birth weight infants decreased significantly,and the main causes of death were respiratory distress syndrome and severe asphyxia. In clinical practice,neonatal resuscitation level and timely application of pulmonary surfactant in the delivery room should be further improved,and publicity and education of prenatal health care in surrounding districts and counties should be strengthened so as to improve the prenatal compliance.
引文
[1]邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].第4版.北京:人民卫生出版社,2011:64.
[2]沈晓明,王卫平.儿科学[M].第7版.北京:人民卫生出版社,2008:104.
[3]王庆红,杨于嘉,魏克伦,等. 2005年中南地区产科新生儿流行病学调查[J].中国当代儿科杂志,2011,13(6):458-461.
[4]中华医学会新生儿学组.中国城市早产儿流行病学初步调查报告[J].中国当代儿科杂志,2005,7(1):25-28.
[5]曾军安,李占魁,李清红,等. 117例极低和超低出生体重儿并发症及结局分析[J].中国妇幼健康研究,2015,26(4):724-726.
[6]汤亚南,魏玲,唐燕燕,等.极低和超低出生体重儿生存随访和放弃治疗院内因素分析[J].中国当代儿科杂志,2011,13(9):711-714.
[7]王恋,李娟,毛健,等.极低和超低出生体重儿的预后因素分析[J].中国当代儿科杂志,2014,16(6):601-605.
[8]阚清,杨洋,周晓玉,等.超低/极低出生体质量儿223例临床回顾性分析[J].东南大学学报:医学版,2016,35(5):713-718.
[9]刘江勤,黄丽萍,严虎,等.极低出生体重早产儿143例结局[J].中国新生儿科杂志,2012,27(4):243-246.
[10]李明玉,唐军,伍金林,等.极低与超低出生体质量儿的临床分析[J].中华妇幼临床医学杂志(电子版),2014,10(3):44-48.
[11]李爱月,杨宇萍.极低和超低出生体重儿临床分析[J].中国新生儿科杂志,2016,31(1):24-27.
[12]胡勇,唐军,夏斌,等. 1146例极低/超低出生体重儿临床资料分析[J].中华妇幼临床医学杂志(电子版),2017,13(2):149-155.
[13]CALLAGHAN W M, MACDORMAN M F, SHAPIROMENDOZA C K,et al. Explaining the recent decrease in US infant mortality rate,2007-2013[J]. Am J Obstet Gynecol,2017,216(1):73.e1-73.e8.
[14]尚利宏,梁盼盼,杨真录,等. 2010-2015年296例住院新生儿死亡病例分析[J].中国妇幼保健,2017,32(16):3840-3842.
[15]石锋. 2004年-2015年349例新生儿死亡情况分析[J].中国病案,2017,16(7):120-122.
[16]吴繁,范茜,王律,等.新生儿科住院死亡患儿的相关因素分析[J].中华新生儿科杂志,2017,32(3):169-175.
[17]高瑛,张磊,赵子艳,等.极低及超低出生体重儿115例分析[J].中华实用诊断与治疗杂志,2015,29(12):1207-1209.
[18]冯江,袁秀琴,朱军,等.中国2000-2010年5岁以下儿童死亡率和死亡原因分析[J].中华流行病学杂志,2012,33(6):558-561.
[19]中国新生儿复苏项目专家组.中国新生儿复苏指南(2016年北京修订)[J].中国新生儿科杂志,2016,31(4):241-246.
[20]WYCKOFF M H,AZIZ K,ESCOBEDO M B,et al. Part 13:Neonatal Resuscitation:2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care[J]. Circulation,2015,132(18Suppl 2):S543-S560.
[2]沈晓明,王卫平.儿科学[M].第7版.北京:人民卫生出版社,2008:104.
[3]王庆红,杨于嘉,魏克伦,等. 2005年中南地区产科新生儿流行病学调查[J].中国当代儿科杂志,2011,13(6):458-461.
[4]中华医学会新生儿学组.中国城市早产儿流行病学初步调查报告[J].中国当代儿科杂志,2005,7(1):25-28.
[5]曾军安,李占魁,李清红,等. 117例极低和超低出生体重儿并发症及结局分析[J].中国妇幼健康研究,2015,26(4):724-726.
[6]汤亚南,魏玲,唐燕燕,等.极低和超低出生体重儿生存随访和放弃治疗院内因素分析[J].中国当代儿科杂志,2011,13(9):711-714.
[7]王恋,李娟,毛健,等.极低和超低出生体重儿的预后因素分析[J].中国当代儿科杂志,2014,16(6):601-605.
[8]阚清,杨洋,周晓玉,等.超低/极低出生体质量儿223例临床回顾性分析[J].东南大学学报:医学版,2016,35(5):713-718.
[9]刘江勤,黄丽萍,严虎,等.极低出生体重早产儿143例结局[J].中国新生儿科杂志,2012,27(4):243-246.
[10]李明玉,唐军,伍金林,等.极低与超低出生体质量儿的临床分析[J].中华妇幼临床医学杂志(电子版),2014,10(3):44-48.
[11]李爱月,杨宇萍.极低和超低出生体重儿临床分析[J].中国新生儿科杂志,2016,31(1):24-27.
[12]胡勇,唐军,夏斌,等. 1146例极低/超低出生体重儿临床资料分析[J].中华妇幼临床医学杂志(电子版),2017,13(2):149-155.
[13]CALLAGHAN W M, MACDORMAN M F, SHAPIROMENDOZA C K,et al. Explaining the recent decrease in US infant mortality rate,2007-2013[J]. Am J Obstet Gynecol,2017,216(1):73.e1-73.e8.
[14]尚利宏,梁盼盼,杨真录,等. 2010-2015年296例住院新生儿死亡病例分析[J].中国妇幼保健,2017,32(16):3840-3842.
[15]石锋. 2004年-2015年349例新生儿死亡情况分析[J].中国病案,2017,16(7):120-122.
[16]吴繁,范茜,王律,等.新生儿科住院死亡患儿的相关因素分析[J].中华新生儿科杂志,2017,32(3):169-175.
[17]高瑛,张磊,赵子艳,等.极低及超低出生体重儿115例分析[J].中华实用诊断与治疗杂志,2015,29(12):1207-1209.
[18]冯江,袁秀琴,朱军,等.中国2000-2010年5岁以下儿童死亡率和死亡原因分析[J].中华流行病学杂志,2012,33(6):558-561.
[19]中国新生儿复苏项目专家组.中国新生儿复苏指南(2016年北京修订)[J].中国新生儿科杂志,2016,31(4):241-246.
[20]WYCKOFF M H,AZIZ K,ESCOBEDO M B,et al. Part 13:Neonatal Resuscitation:2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care[J]. Circulation,2015,132(18Suppl 2):S543-S560.