如何降低新生儿窒息的发生率病死率和致残率

如何降低新生儿窒息的发生率病死率和致残率黄德珉据我国孕妇和儿童生命监测网统计，新生儿死亡占婴儿死亡率的７０％，死于１周以内的新生儿占新生儿死亡率的６０％，其中尤以生后第１天第１小时为最多。主要死亡原因为窒息，复苏欠佳时存活者致残率也较高。为了实现《９...     

新生儿窒息相关因素分析及预防

本文通过对我院 2 0 5例新生儿窒息原因分析 ,以期达到及早防治围生儿死亡率及发病率的目的。资料与方法一、一般资料　我院 1995年 1月～ 2 0 0 0年 1月共分娩活婴 3986例 ,其中窒息儿 2 0 5例 ,发生率 5 .14%。二、方法　新生儿窒息的诊断　采用Ａｐｇａｒ评分 ,本组轻度窒息 133例 ,占 3 .34% ,重度窒息 72例 ,占 1.8%。三、新生儿窒息及其相关因素　ＩＵＧＲ占 33.33 % ,妊高征、胎盘早剥均占 2 2 .5 9% ,孕妇合并症占 2 0 % ,过期妊娠占 18.18% ,胎膜早破占 17.43 % ,早产占 17.6 5 % ,前置胎盘占 19.2 3 % ,脐带因素占 12 .47%。四、…     

新生儿窒息相关因素分析

为降低围生儿死亡率 ,减少病残儿的发生 ,提高产科质量 ,本文对影响新生儿窒息的相关因素进行回顾性分析 ,以期达到及早防治围生儿死亡及新生儿窒息的目的。临床资料一、一般资料　 2 0 0 0年 1月～ 2 0 0 2年 12月共分娩活婴2 0 16例 ,其中窒息儿 183例 ,轻度窒息 14 1例 ,重度 4 2例。表 1　新生儿窒息与各种因素关系 [n( % ) ]孕　周<3 7　 3 7～ 42　 >42体重 (g)<2 5 0 0　～ 3 999　≥ 40 0 0自然分娩手术方式臀牵引　胎吸　剖宫产产程正常　异常胎儿窘迫　有　无　脐带因素　有　无　活婴 2 2 0 14 3 3 3 63 2 42 1611163 13 0 662 1…     

流动人口新生儿窒息的临床特点及围产因素分析

<正>随着上海浦东的改革开放,外来人员的大量涌入,分娩新生儿总数中外来户籍的比例也在逐年增加。我院地处上海市浦东新区城乡结合部,就医病人中流动人口多,且大部分为外来务工人员。流动人口是指现居住地不是户籍所在地,异地从事务工、经商等活动或者以生育为目的异地居住的人群[1]。如何降低该群体新生儿窒息的发病率及病死率,是     

新生儿窒息252例及其相关因素分析

为了进一步降低新生儿窒息的发生率和病死率,本文对我院产科1995年2月～1999年2月新生儿窒息的情况进行回顾,并对252例窒息新生儿进行分析。临床资料与方法1995年2月～1999年2月我院分娩新生儿2886人,发生新生儿窒息252例,占8.7%。其中轻度窒息138例,占54.8%,重度窒息114例,占45.2%。诊断方法采用Ａｐｇａｒ评分法。结　　果一、新生儿窒息的主要因素　见表1。同期足月正常产2144例,发生窒息105例,占4.9%。两者相比有显著性差异(Ｐ<0.01)。表1　252例新生儿窒息有关因素和分娩方式分析与窒息有关因素ｎ窒息ｎ(%)分娩方式ｎ窒息ｎ(%)妊高征21…     

210例新生儿窒息的高危因素分析

目的 探讨新生儿窒息的发病危险因素,为防治新生儿窒息提供经验.方法 对210例窒息患儿及420例对照进行1∶2匹配病例对照研究.采用单因素、多因素Logistic回归分析方法,筛选新生儿窒息的危险因素.结果 多因素分析显示,胎盘异常、低出生体重、胎膜早破、羊水异常、妊娠高血压综合征、早产、胎儿窘迫、脐带异常、产钳助产是新生儿窒息的主要危险因素.结论 积极预防和消除新生儿窒息发病的各种危险因素,可望降低新生儿窒息的发生率.     

早产儿404例脑损伤发生率及相关因素分析

目的调查我院住院早产儿脑损伤发生率及影响因素。方法对2003年8月至2005年10月我院收治的404例早产儿应用ABR4000S/L B超诊断仪在生后3~7d内常规进行床边头颅B超检查。结果150例早产儿存在脑损伤,平均胎龄为(33·27±1·99)周;平均出生体重(1993±505)g。总的脑室内出血发生率35·2%(142/404),脑室周围白质软化的发生率3·5%(14/404),轻度脑损伤发生率23·5%(95/404),重度脑损伤发生率13·6%(55/404)。胎龄越小,体重越低,脑损伤发生率越高,但与颅内出血程度无关。妊高征、宫内窘迫、胎龄、高频振荡通气治疗、出生时窒息、出生体重可使早产儿脑损伤发生率增高。结论早产儿脑损伤的发生及严重程度与多因素有关,头颅B超可对早产儿脑损伤作出早期诊断,为早期干预提供依据。     

早产儿404例脑损伤发生率及相关因素分析

目的 调查我院住院早产儿脑损伤发生率及影响因素.方法 对2003年8月至2005年10月我院收治的404例早产儿应用ABR4000S/L B超诊断仪在生后3～7 d内常规进行床边头颅B超检查.结果 150例早产儿存在脑损伤,平均胎龄为(33.27±1.99)周;平均出生体重(1 993±505)g.总的脑室内出血发生率35.2%(142/404),脑室周围白质软化的发生率3.5%(14/404),轻度脑损伤发生率23.5%(95/404),重度脑损伤发生率13.6%(55/404).胎龄越小,体重越低,脑损伤发生率越高,但与颅内出血程度无关.妊高征、宫内窘迫、胎龄、高频振荡通气治疗、出生时窒息、出生体重可使早产儿脑损伤发生率增高.结论 早产儿脑损伤的发生及严重程度与多因素有关,头颅B超可对早产儿脑损伤作出早期诊断,为早期干预提供依据.     

新生儿重度窒息器官损害及死亡危险因素分析(英文)

目的：回顾性分析我院170例新生儿重度窒息的临床情况及各脏器受累损伤程度,了解与死亡有关的危险因素。方法：对1993～2004年我院NICU收治的重度窒息新生儿170例资料进行分析,用SAS软件对与死亡有关危险因素进行OR分析。结果：170例中死亡22例(12.5%),165例(97.1%)出现各脏器的并发症,各脏器受累机会的次序依次为中枢神经系统,肺,代谢系统等;严重程度依次为代谢,肺,中枢神经系统等。与死亡有关的危险因素依次为中枢神经系统严重受累,1个以上脏器严重受损,呼吸衰竭,代谢紊乱,电解质紊乱,血气异常,肺损害,10分钟Apgar评分≤3,胎龄<37周,肝脏损害,心脏损害,PCO2增高和血液系统损伤。结论：器官/系统损害是除HIE外新生儿重度窒息的主要并发症,严重威胁生命并且可以导致死亡;对于一些造成死亡的危险因素应该引起重视和早期干预。     

Birthweight Specific Perinatal Mortality in Greece

ABSTRACT. Data from the Greek Perinatal Study in April 1983 revealed an excessively high perinatal mortality rate of 21.6 per 1000 total births among singletons despite a low birthweight rate of only 4.5%. Comparison of perinatal mortality rates with Danish mortality rates in 1983, revealed the Greek rates to be three times higher than those in Denmark. When divided by time of death, the Greek stillbirth rates were two times higher and the early neonatal mortality rates were four times higher than the corresponding Danish rates. Subdivision of the Greek perinatal deaths using the Wigglesworth classification showed that the biggest group (40%) consisted of deaths associated with intrapartum asphyxia. The incidence of such deaths was 10 times higher than that found in Denmark. We conclude that in reducing the excessively high perinatal mortality rate in Greece special attention should be made to improve intrapartum and resuscitation techniques.     

Perinatal Mortality in Jamaica 1986-1987

ABSTRACT. A large population-based study of all stillbirths and neonatal deaths occurring on the island of Jamaica during a 12 month period is described. During this time, 2069 perinatal deaths were identified in an estimated total of 54400 infants born giving a perinatal death rate of 38.0 per 1000 births. The death rate was 5 times higher among twins than singletons. An attempt was made to obtain detailed postmortem examination of as many cases as possible. In the event, 51 % of the infants who died perinatally had such postmortem examination. Postmortem rate was affected by sex, multiplicity of the infant, time of death, month of death and area of delivery. Deaths were classified using the Wigglesworth scheme. The distribution of categories was similar in the months when the postmortem rate was 70 % to the rest of the time period when the post-mortem rate was only 40 %. The Wigglesworth classification of deaths identified those associated with intrapartum asphyxia as the most important group, accounting for over 40 % of deaths overall and 59 % of deaths in infants of more than 2 500 g birthweight. Antepartum fetal deaths were the second largest group, comprising 20 % of deaths. Sixty percent of the infants in this group weighed less than 2 500 g at birth. Major malformations were responsible for few perinatal deaths in Jamaica. This simple classification is important as it focusses attention on details of labour and delivery that may require change and is useful in planning future delivery of obstetric and neonatal care.     

Pre- and Perinatal Factors and the Risk of Subsequent Referral for Hyperactivity

Possible pre- and perinatal risk factors for subsequent referral for hyperactivity were assessed by comparing birth records of 129 referrals with the remaining 24,656 members of a geographically defined birth cohort. Relationships between the risk factors were accounted for using logistic regression methods. The significant factors were: social class, maternal age, antepartum haemorrhage, length of labour (second stage), 1-min Apgar and sex. Associations between referral for hyperactivity and the pregnancy, labour and birth outcome factors were not explained by the socio-demographic variables. The results suggest that such factors have a statistically significant association with referral for hyperactivity and may be of modest aetiological importance. However, the predictive power of the final set of factors remained low even on the original data set.     

高胆红素血症足月新生儿的高危围生因素

目的 探讨高胆红素血症(NHB)新生儿的高危围生因素.方法 应用经皮胆红素测定仪监测5 616例足月新生儿出生7 d内血清胆红素水平,记录围生期可能与新生儿黄疸有关的17种围生因素(性别、胎次、胎龄、母亲年龄、宫窘迫史、产式、出生体质量、催产素应用情况,Apgar评分、生后开奶时间、首次胎粪排出时间、喂养方式、出血、抗生素的应用、血糖、红细胞比容、1周内体质量下降情况),将各围生因素对黄疸的影响,分别进行单因素分析和Logistic多因素回归分析.测定48例足月黄疸新生儿经皮胆红素与血清总胆红素水平,采用直线相关与回归分析和Logistic多元回归分析.结果 1.黄疸新生儿48例经皮和血清总胆红素水平为(227.89±41.53) μmol/L和(212.77±36.17) μmol/L,经直线相关分析,二者呈正相关(r=0.924 P<0.001).2.引起NHB的围生因素包括胎龄、产式、胎儿宫内窘迫、应用催产素、开奶时间延迟、胎粪排出时间延迟、喂养方式、出血、低血糖、红细胞比容和体质量下降.其中引起NHB独立的高危围生因素为胎龄、产式、开奶时间延迟、喂养方式、低血糖、红细胞增多症和体质量下降.结论 加强围生期保健、提倡经阴道分娩和及早开奶是预防围生期NHB的有效措施之一.     

小儿死亡危险评分的临床应用

目的观察小儿死亡危险评分(PRISM评分)与PICU急性危重症患儿预后的关系。方法对2003年2-10月PICU收治急性危重症45例,回顾性评定PRISM评分,并依据评分分组,记录患儿临床资料和住院时间、预后。结果PRISM 评分<15分24例,>15分21例。两组年龄、体质量和院内感染率均无显著差异(P均>0.05)。两组死亡率分别为8.1%(2/ 24例)和38.1%(8/21例),PRISM评分<15分组死亡率明显低于>15分组(x2=4.14 P<0.05)。PRISM>15分组存活病例住院天数(13.2±6.1)d显著长于PRISM<15分组(9.7±8.5)d(t=1.74.P<0.05)。结论PRISM评分越高,死亡率随之增加。PRISM评分增高,患儿住院时间越长。PRISM评分能够准确评估急性危重症病人的严重程度和预后。     

Pre- and Perinatal Factors in Febrile Convulsions

Forsgren, L., Sidenvall, R., Blomquist, H. K:son, Heijbel, J. and Nyström, L. (Departments of Neurology, Paediatrics and Epidemiology and Health Care Research, University Hospital, Umeå, Sweden). Acta Paediatr Scand 80: 218, 1991.
In a community based study, 110 children with febrile convulsions (FC) were identified prospectively. Pre- and perinatal risk factors were compared with 213 age and sex matched controls sampled from the community. During pregnancy, proteinuria and preeclampsia/eclampsia Occurred more often in mothers of cases. Premature birth and bilirubinemia ≥ 200 μmol/l were also more common in cases. There were no differences between cases and controls in Occurrence of chronic illnesses in mothers, parents age at birth, birth order, and factors occurring during delivery such as type of anesthesia, Occurrence of acute or elective cesarean section, use of vacuum extraction, mode of presentation, signs of fetal distress in amnion fluid, umbilical problems, abnormalities of fetal heart rate or duration of delivery. Perinatal asphyxia was uncommon and there was no difference between cases and referents. Occurrence of complications during the first neonatal week did not differ between groups.     

儿童铅中毒高危因素分析

目的探讨儿童铅中毒发生的高危因素,以便能更好地进行预防。方法选择1055例门诊患儿。年龄5个月~16岁,平均(7.2±3.5)岁。应用3010-B血铅分析仪对患儿进行血铅测定;同时对每位患儿进行铅中毒影响因素问卷调查。结果儿童血铅水平(110.1±41.9)μg/L,铅中毒(血铅≥100μg/L)检出率为43.51%,各年龄组血铅水平无显著差异。多因素逐步回归分析显示,对儿童血铅水平发生显著影响因素依次是不勤洗手、经常吃膨化食品、偏(挑)食、不常补钙和锌及经常居室装修。结论不良的饮食和生活习惯是儿童铅中毒发生的高危因素。     

婴儿捂热综合征死亡的危险因素

目的探讨婴儿捂热综合征（IMS）死亡的危险因素。方法回顾性分析2002年1月-2007年2月63例IMS患儿的临床资料，按照是否并代谢性酸中毒、高血糖、低血钙、超高热，及儿童危重病例评分（PCIS）、脏器衰竭数目对患儿进行分组，对各项危险因素行χ^2检验，比较组间患儿的病死率。结果63例患儿住院期间病死率为22．1％。并代谢性酸中毒与未并代谢性酸中毒患儿病死率比较差异有统计学意义（RR=3．20，95％CI=1．0～10．24，χ^2=4．76P〈0．05），且病死率随着血pH降低而升高（Pearson列联系数=0．49，χ^2=9．80P〈0．05）。存活48例与15例死亡患儿PCIS评分相比有显著差异（t=7．798P〈0．05）。PCIS≤80分与〉80分患儿的病死率相比有显著差异（RR=12．73，95％CI=1．78～91．04，χ^2=13．24P〈0．05）。血糖〉12mmol／L的患儿与血糖〈12mmol／L的患儿相比差异有统计学意义（RR=3．73，95％CI=1．46～9．54，χ^2=8．73P〈0．05）。并低血钙与未并低血钙的患儿病死率相比有显著差异（RR=3．0,95％CI=1．23—7．31，χ^2=6．30P〈0.05）。体温≥41℃与体温〈41℃的患儿病死率相比有显著差异（RR=3．0，95％CI=1．34～6．74，χ^2=3．97P〈0．05）。脏器衰竭≥3个与脏器衰竭〈3个的患儿病死率相比有显著差异（RR=7．88，95％a=2．85～21．78，χ^2=17．66P〈0．05）。结论代谢性酸中毒、高血糖、低血钙、超高热、低PCIS评分及多脏器衰竭可能是IMS的死亡危险因素。     

川崎病并冠状动脉损害的危险因素

目的探讨川崎病(KD)并冠状动脉损害(CAL)的危险因素。方法收集1999年1月-2001年12月住院的145例KD患儿的临床资料,分析无CAL93例和CAL52例患儿的实验室检查资料及治疗、随访结果。结果无CAL组发热日程(8.7±3.4)d.血沉(79.5±34.6)mm/1h,CAL组发热日程(11.5±4.8)d,血沉(91.9±36.6)mm/1h,两组比较差异有显著性(P<0.01,0.05)。发病10d内接受静脉注射人血丙种球蛋白(IVIG)治疗患儿CAL发生率为18.8%(18/96),未予IVIG治疗患儿CAL发生率为69.4%(34/49),两者比较差异有显著性(P<0.001)。随访并CAL患儿38例,冠状动脉扩张20例均恢复正常;14例冠状动脉瘤中12例恢复正常,2例缩小;4例巨大冠状动脉瘤2例缩小,另2例超过2年仍未恢复。结论KD并CAL与热程过长及血沉显著增快密切相关,病程早期未予IVIG治疗的患儿并CAL的危险性明显增高,应用IVIG治疗对防治冠状动脉损害有重要作用。     

窒息新生儿胃运动及影响因素的研究

目的　研究窒息足月新生儿胃电运动、血浆胃动素及血清一氧化氮 (NO)变化规律 ,对窒息新生儿消化运动功能进行评价 ,为探讨有效的干预对策提供理论依据。方法　对足月窒息新生儿 2 9例餐后体表胃电图、血浆胃动素、血清NO进行检测 ,并以正常新生儿做对照。结果　窒息组正常胃慢波百分比 (PNSW )明显低于对照组 ,分别为 (3 5 .3 5± 2 2 .5 1) %与 (4 9.78±18.80 ) % ,两组比较P <0 .0 5 ,而异常慢波百分比 (PUSW)却明显高于对照组 ,分别为 (5 5 .66± 2 9.3 9) %与 (3 1.99± 13 .79) % ,两组比较P <0 .0 1。PNSW轻度窒息组明显高于重度窒息组 (P <0 .0 5 )。窒息组和对照组餐后血浆胃动素分别为 (3 0 1.47± 73 .3 1)ng/L和 (4 3 6.5 8± 185 .5 7)ng/L ,窒息组明显低于对照组 (P <0 .0 0 1)。窒息组餐后血清NO为 (110 .61± 13 .75 ) μmol/L ,对照组为(98.66± 0 .72 ) μmol/L ,窒息组明显高于对照组 (P <0 .0 1)。窒息组异常PUSW与血浆胃动素呈显著负相关 (P <0 .0 0 1) ;PUSW与血清NO呈显著正相关 (P <0 .0 1) ;血浆胃动素与血清NO呈显著负相关 (P <0 .0 1)。结论　窒息新生儿存在胃电基本节律紊乱、胃动素水平降低和NO水平升高 ,提示窒息后新生儿的胃肠动力障碍与神经体液调节异常有关。