新生儿重度缺氧缺血性脑病123例临床与随访分析

发布时间：2018-10-24 13:04

【摘要】：目的分析新生儿重度缺氧缺血性脑病(HIE)的临床特点及随访情况,为合理诊治及随访提供依据。方法选择2011年1月至2014年10月我院足月新生儿病房收治的重度HIE患儿临床资料进行回顾性分析,总结患儿一般资料、辅助检查、治疗、转归、随访和预后情况,对影响患儿预后的因素进行多元Logistic回归分析。结果共纳入123例重度HIE患儿,除常规治疗外,6例予亚低温治疗,21例予高压氧治疗,治疗好转60例,放弃治疗55例,住院死亡8例。单因素分析显示5 min Apgar评分、惊厥、昏迷、p H、BE、脏器损伤、亚低温治疗是影响重度HIE患儿预后的危险因素;多因素分析显示5 min Apgar评分3分(OR=4.071,95%CI 1.309~15.613)、BE≤-10 mmol/L(OR=36.810,95%CI 5.913~41.119)是影响重度HIE患儿预后的独立危险因素(P0.05),入院日龄72 h(OR=0.096,95%CI 0.026~0.353)是影响重度HIE患儿预后的保护性因素。重度HIE患儿易合并脏器损伤和电解质紊乱,其中脏器损伤以脑、肺、心损伤最常见,电解质紊乱以低钙、低钠多见。123例患儿中,33例失访,49例死亡(8例住院期间死亡,41例放弃治疗后死亡),死亡原因前五位分别为因经济因素及担心后遗症放弃治疗(20例)、多脏器功能损伤(16例)、气胸(4例)、弥散性血管内凝血(6例)、休克(3例)。41例存活患儿进行9~54个月随访,5例继发脑瘫,3例继发癫疒间;7例发育大致正常;其余26例发育落后于同龄患儿。结论重度HIE患儿病死率高,合并症多,留有后遗症比率高。及时发现危险因素是预防重度HIE的关键,对重度HIE更远期预后的随访工作需积极开展。
[Abstract]:Objective to analyze the clinical features and follow-up of severe hypoxic ischemic encephalopathy (HIE) in neonates. Methods the clinical data of severe HIE patients admitted to our hospital from January 2011 to October 2014 were retrospectively analyzed. The general data, auxiliary examination, treatment, outcome, follow-up and prognosis were summarized. Multivariate Logistic regression analysis was used to analyze the prognostic factors of children. Results A total of 123 children with severe HIE received mild hypothermia treatment in 6 cases, hyperbaric oxygen therapy in 21 cases, improvement in 60 cases, abandonment in 55 cases and hospital death in 8 cases. Univariate analysis showed that 5 min Apgar score, convulsion, coma, pHG, organ injury and mild hypothermia therapy were risk factors for prognosis of severe HIE patients. Multivariate analysis showed that the 5 min Apgar score (OR=4.071,95%CI 1.309 卤15.613), BE 鈮，

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