影响新生儿破伤风预后危险因素的单因素分析

发布时间：2018-05-20 14:32

  本文选题：新生儿 + 破伤风　； 参考：《重庆医科大学》2012年硕士论文

【摘要】：目的：探讨影响新生儿破伤风（Neonatal tetanus.NT)预后的危险因素，，为临床判断病情轻重、选择治疗方案及改善其预后提供积极的指导作用。 方法：对2000年1月-2010年1月收住重庆医科大学附属儿童医院新生儿病房的71例NT患儿进行回顾性分析，根据病情状况分为轻型、中型、重型，根据转归将其分为治愈组与病死组，通过调查表统计NT患儿的临床资料，采用回顾性研究方法，比较它们之间预后的差异，单因素分析与死亡有关联的高危因素。 结果：79例NT患儿中排除8例自动出院，有效病例71例。对有效病例进行统计分析，结果为71例病例中治愈45例，死亡26例，病死率为36.6%。患儿出生时均未注射破伤风抗毒素（TAT）进行预防，母孕期均未给予破伤风内毒素（TT)预防接种。患儿父母均为农村或外来打工人员家庭。旧法接生62例（占87.3%），当地医院或诊所接生9例（占12.7%）。男女比例1.4：1，平均出生体重2780.77±6.65g，早产儿25例（占35.2%），平均胎龄38.6±4.2w。入院时临床表现：苦笑面容71例（占100%）、牙关紧闭71例（占100%）、四肢肌张力增高71例（占100%）、烦躁及哭吵不安68例（占95.8%）、张口困难65例（占91.5%）、频繁抽搐63例（占88.7%）、角弓反张60例（占84.5%）、喂养困难及拒乳55例（占77.5%）、呼吸困难52例（占73.2%）、发绀49例（占69.1%）、窒息31（占43.7%）。 根据病情状况轻型25例(潜伏期多在14d以上，表现为牙关紧闭或局部肌肉强直)，自动出院1例，死亡1例，病死率占4.2%（1/24)；中型33例(潜伏期7～14d，发病48h以后出现痉挛，表现为牙关紧闭，吞咽困难，全身肌肉强直，并出现阵发性肌肉痉挛)，自动出院3例，死亡9例，病死率占30.0%（9/30）；重型21例(潜伏期7d以内，发病48h内出现痉挛，表现为牙关紧闭，全身肌肉强直伴频繁严重的痉挛，不易控制)。自动出院4例，死亡16例，病死率占94.2%（16/17）。治愈的45例患儿中轻型23例，占51.1%（23/45），中型21例，占46.7%（21/45），重型1例，占2.2%（1/45）；死亡的26例病例中轻型1例，占3.8%（1/26），中型9例，占34.6%（9/26），重型16例，占61.5%（16/26）。 单因素分析发现影响NT预后的高危因素有：胎龄、开始治疗的时间、潜伏期、痉挛前期、起病期、痉挛持续时间、痉挛发作间期、止痉药剂量大小及合并肺炎、败血症、窒息、呼吸衰竭、硬肿症、高血糖、低钠血症、白细胞异常（WBC≤5×109/L或≥20×109/L）、C反应蛋白升高（CRP≥8g/L）、血小板减少(PLT＜100×109/L)。 结论：胎龄、开始治疗的时间、潜伏期、痉挛前期、起病期、痉挛持续时间、痉挛发作间期、止痉药剂量大小及合并肺炎、败血症、窒息、呼吸衰竭、硬肿症、高血糖、低钠血症、白细胞异常（WBC≤5×109/L或≥20×109/L）、C反应蛋白升高（CRP≥8g/L）、血小板减少(PLT＜100×10~9/L)是影响NT预后的危险因素。积极防治影响NT患儿预后的高危因素，可降低病死率，提高治疗的成功率。
[Abstract]:Objective: to explore the risk factors influencing the prognosis of Neonatal tetanus (NT), and to provide positive guidance for clinical judgement, selection of treatment plan and improvement of prognosis of Neonatal tetanus. Methods: from January 2000 to January 2010, 71 cases of NT in neonatal ward of affiliated Children's Hospital of Chongqing Medical University were retrospectively analyzed. According to the condition of the disease, they were divided into light, medium and severe. According to the outcome, the patients were divided into two groups: the cured group and the dead group. The clinical data of children with NT were analyzed by questionnaire, and the difference of prognosis between them was compared by retrospective study, and the high risk factors associated with death were analyzed by univariate analysis. Results among 79 cases of NT, 8 cases were excluded and 71 cases were effective. The results showed that 45 cases were cured, 26 cases died and the mortality rate was 36.6%. No tetanus antitoxin was injected into the children at birth, and no tetanus endotoxin TTT was given to the mother during pregnancy. The parents of the children were both rural or migrant workers' families. 62 cases (87.3%) were delivered by the old method, 9 cases (12.7%) were delivered in local hospitals or clinics. The ratio of male to female was 1.4: 1, the average birth weight was 2780.77 卤6.65 g, and the average gestational age was 38.6 卤4.2 wks in 25 premature infants (35.2%). Clinical manifestations on admission: 71 cases (100 cases) with bitter smile, 71 cases (100 cases) with closed jaw, 71 cases (100 cases) with increased muscular tension in limbs (100 cases), 68 cases (95.888%) with restlessness and crying, 65 cases (91.5%) with difficulty in opening mouth, 63 cases (88.77%) with frequent convulsions, and 63 cases (88.77%) with angle arch. There were 60 cases (84.5%) of regurgitation, 55 cases (77.5%) of difficulty in feeding and refusing milk, 52 cases (73.2%) of dyspnea, 49 cases of cyanosis (69.1%), 31 cases of asphyxia (43.7%). According to the condition of the disease, 25 cases were mild (the incubation period was more than 14 days). The symptoms were closed teeth or local muscular rigidity, 1 case was discharged automatically, 1 case died, the mortality rate was 4.22 / 24%, 33 cases (incubation period 7 days 14 days later) developed spasm 48 hours after onset. The symptoms included tight jaw, dysphagia, muscular rigidity, paroxysmal muscle spasm, automatic discharge from hospital in 3 cases, death in 9 cases, mortality rate of 30.030%, and severe cases (within 7 days of incubation period, spasm within 48 hours of onset). Systemic muscular ankylosis with frequent and severe spasms is difficult to control. 4 cases were discharged automatically, 16 cases died, the mortality rate was 94. 2% / 17%. Of the 45 cases cured, 23 were mild (51.1 / 23 / 45), 21 were moderate (46.7 / 45), 1 was severe (2.2 / 45 / 45), 1 was light (3.826 / 26), 9 were medium-sized (34.699 / 26), 16 were heavy (61.5 / 16 / 26). Univariate analysis showed that the high risk factors influencing the prognosis of NT were gestational age, time of beginning treatment, incubation period, prespasticity, onset stage, spasmodic duration, spasmodic interval, size of antispasmodic agent and complicated pneumonia, septicemia, asphyxia. Respiratory failure, scleres, hyperglycemia, hyponatremia, leukocyte abnormalities WBC 鈮

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