足月单胎新生儿窒息影响因素分析

目的 调查深圳市龙岗区足月单胎新生儿窒息发病情况及主要影响因素。方法 采取整群抽样方法调查深圳市龙岗区23家助产医院2017年1 - 12月所分娩的27 439例足月活产新生儿及其母亲作为研究对象，分析新生儿窒息情况，按是否发生新生儿窒息分为窒息组和正常组，使用卡方检验和多因素logistic回归分析其影响因素。结果 龙岗区足月单胎新生儿窒息发生率为0.46%(127/27 439)。两组母亲孕次、产次、羊水、胎盘、脐带、分娩方式及胎儿胎方位、性别、畸形、出生体重等分布进行比较，差异均有统计学意义(P＜0.05)。多因素logistic回归显示，初产妇(aOR = 1.48, 95%CI = 1.02~2.14)、脐带异常(aOR = 1.85，95%CI = 1.08～3.17)、产钳助产(aOR = 8.44，95%CI = 4.20～16.97)、抬头吸引(aOR = 14.27，95%CI = 3.31～61.53)、臀位助产(aOR = 12.00，95%CI = 1.46～98.79)、男婴(aOR = 2.06，95%CI = 1.40～3.03)、胎儿畸形(aOR = 3.69，95%CI = 2.04～6.66)、出生体重＜2 500 g(aOR = 2.67，95%CI = 1.14～6.26)为足月单胎新生儿窒息的危险因素。结论 足月单胎新生儿出生窒息的影响因素有初产妇、脐带异常、助产、男婴、低出生体重和存在畸形，提示我们应加强围生期管理，提高助产水平，减少新生儿窒息的发生。

Analysis of the influencing factors of asphyxia in term singleton

The aim of this study was to investigate the prevalence and main influencing factors of asphyxia of termsingleton in Longgang District, Shenzhen. Methods Cluster sampling method was used to investigate the 27439 full-term livenewborns and their mothers delivered in 23 midwifery hospitals in Longgang District of Shenzhen from January to December2017. The asphyxia of newborns was analyzed. According to the occurrence of asphyxia of newborns, they were divided intothe occurrence group and the non-occurrence group. The influencing factors were analyzed by single factor analysis of varianceand multi factor logistic regression. Results The incidence of asphyxia was 0.46% (127/27439). There were significantdifferences between the two groups in distribution of maternal pregnancy, primipara/multipara, amniotic fluid, placenta,umbilical cord, delivery mode, fetal position, gender, deformity, and birth weight (P<0.05). The multivariate logistic regressionanalysis indicated that the risk factors of asphyxia in full-term singletons included primipara (aOR=1.48, 95%CI=1.02-2.14),umbilical cord abnormality (aOR=1.85, 95%CI=1.08-3.17), forceps delivery (aOR=8.44, 95%CI=4.20-16.97), head up suction(aOR=14.27, 95%CI=3.31-61.53), breech delivery (aOR=12.00, 95%CI=1.46-98.79), male infant (aOR=2.06, 95%CI=1.40-3.03),fetal malformation (aOR=3.69, 95%CI=2.04-6.66) and birth weight <2500g (aOR=2.67, 95%CI=1.14-6.26). Conclusion Theinfluencing factors of birth asphyxia of full -term singleton were abnormal umbilical cord, midwifery, male infant, low birthweight and deformity. It is suggested that we should strengthen the management of perinatal period, improve the level ofmidwifery and reduce the incidence of neonatal asphyxia.