111例极低出生体重儿的临床分析

发布时间：2018-09-10 17:01

【摘要】：目的：了解我院出生的极低出生体重儿(Very Low Birth Weight Infant, VLBWI)的一般流行病学资料、临床并发症、母亲围产期相关因素以及住院日和住院费用等,为进一步了解VLBWI的临床特点、提高VLBWI的诊治水平、降低住院费用等提供临床参考资料。方法：回顾性分析2013年1月至2015年12月我院出生的VLBWI I临床资料。应用SPSS 17.0进行统计分析,对可能影响VLBWI出院转归的相关因素进行Logistic回归分析。结果： (1)2013-2015年我院产科活产的VLBWI共111例,发生率1.23%,住院死亡率10.8%,放弃率10.8%,治疗好转出院率78.4%。 (2)本课题VLBWI平均出生体重1229.1±200.2g,主要集中在1000～1499g,其中ELBWI占16.2%；平均胎龄31.3士2.4周,主要集中在28～34周,28周以下占8.1%。(3)VLBWI住院期间排名前五的疾病分别是高胆红素血症、贫血、脑室内出血(IVH)、肺炎和新生儿窒息；动脉导管未闭(PDA)的发病率与胎龄成反比(P0.05),RDS和肺炎的发病率与出生体重和胎龄成反比(P0.05)；多胎、PDA和入院内2天使用有创呼吸机是VLBWI预后不良的危险因素(P0.05)。 (4)本研究孕母平均年龄30.7±6.0岁,其中≥35岁27例(24.3%),试管婴儿和多胎分别占18%和38.7%,剖宫产率56.8%,5分钟Apgar评分7的占21.6%,宫内窘迫发生率30.6%,胎膜早破24小时占18.9%,产前类固醇激素使用率55.9%,妊娠期高血压和妊娠期糖尿病发生率分别是33.3%和18.0%,小于胎龄儿发生率60.4%。 (5)入院2天内有创呼吸机使用率34.2%,PS使用率47.0%,与胎龄和出生体重成反比。入院2天内无创呼吸机使用率27.0%,与出生体重成反比,且在28-32周胎龄组要显著高于其他组(P0.05)。 (6)我院VLBWI平均住院日43.0天,平均住院费用6.17万(中位数为4.44万元),与胎龄、体重呈反比；VLBWI的住院费用要显著高于晚期早产儿和足月儿(P0.05)。结论： (1)VLBWI是新生儿死亡的高发人群,是新生儿重症监护室需要重点关注的对象。 (2)VLBWI院内并发症排名前五的分别是高胆红素血症、贫血、IVH、肺炎和新生儿窒息。 (3)多胎、入院内2天内使用有创呼吸和PDA是VLBWI预后不良的危险因素。(4)母亲妊娠期高血压是我院VLBWI发病的主要原因之一。(5)VLBWI的平均住院日长、费用高,与胎龄和出生体重成反比。
[Abstract]:Objective: to investigate the general epidemiological data, clinical complications, maternal perinatal factors, hospitalization days and hospitalization expenses of very low birth weight infants (Very Low Birth Weight Infant, VLBWI) in our hospital, in order to further understand the clinical characteristics of VLBWI. To improve the level of diagnosis and treatment of VLBWI, reduce the cost of hospitalization and so on to provide clinical reference materials. Methods: the clinical data of VLBWI I born in our hospital from January 2013 to December 2015 were analyzed retrospectively. SPSS 17.0 was used for statistical analysis, and Logistic regression analysis was used to analyze the related factors that may influence the outcome of VLBWI. Results: (1) there were 111 cases of VLBWI in obstetrical department of our hospital from 2013 to 2015, the incidence rate was 1.233.The hospital mortality rate was 10.8, the abandonment rate was 10.8, and the rate of treatment improvement was 78.4%. (2) the average birth weight of VLBWI was 1229.1 卤200.2g.The average birth weight of VLBWI was 1229.1 卤200.2g.The average gestational age of ELBWI was 16.299g, and the mean gestational age was 31.3 卤2.4 weeks. (3) the top five diseases of VLBWI in hospitalization were hyperbilirubinemia and anemia, and the mean gestational age was 31.3 卤2.4 weeks. (3) the first five diseases of VLBWI in hospital were hyperbilirubinemia and anemia, respectively. Intraventricular hemorrhage (IVH),) pneumonia and neonatal asphyxia, the incidence of patent ductus arteriosus (PDA) was inversely proportional to gestational age (P0.05), and the incidence of pneumonia was inversely proportional to birth weight and gestational age (P0.05). Multiple fetal PDA and 2 days of invasive ventilator were the risk factors for poor prognosis of VLBWI (P 0.05). (4) the average age of pregnant mothers was 30.7 卤6.0 years old. 27 cases (24.3%) were over 35 years of age, 18% and 38.7% of test tube infants and multiple births, respectively. The cesarean section rate of 56.8 minutes and 5 minutes Apgar score 7 accounted for 21.6%, the incidence of intrauterine distress was 30.6%, premature rupture of membranes 24 hours accounted for 18.9%, prenatal steroid hormone utilization rate 55.9%, gestational hypertension and gestational hypertension. The incidence of gestational diabetes mellitus was 33. 3% and 18. 0% respectively. (5) the utilization rate of invasive ventilator within 2 days after admission was 47.0%, which was inversely proportional to the gestational age and birth weight. The utilization rate of non-invasive ventilator was 27.0% in 2 days after admission, which was inversely proportional to birth weight, and was significantly higher in 28-32 weeks gestational age group than in other groups (P0.05). (6) the average hospitalization day of VLBWI in our hospital was 43.0 days, and the average hospitalization cost was 61700 (median 44400 yuan). The hospitalization cost of VLBWI in inverse proportion to gestational age and body weight was significantly higher than that of late premature infants and full-term infants (P0.05). Conclusion: (1) VLBWI is a high risk group of neonatal death and should be paid more attention to in neonatal intensive care unit (NICU). (2) the top five complications of VLBWI were hyperbilirubinemia, anemia, pneumonia and neonatal asphyxia. (3) multiple pregnancy, use of invasive respiration within 2 days of admission and PDA were the risk factors for poor prognosis of VLBWI. (4) pregnancy hypertension was one of the main causes of VLBWI in our hospital. (5) the average length of stay of VLBWI was long and the cost was high, which was inversely proportional to gestational age and birth weight.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R722.6

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