545例新生儿窒息回顾性分析

目的 了解新生儿窒息的发生率，高危因素及其并发症发生情况，为防治新生儿窒息提供经验。方法 回顾性分析45337例活产新生儿中545例窒息新生儿的临床资料，分析新生儿窒息发生率及其影响因素。结果 从2001年至2006年，新生儿窒息发生率从2．13％（113／5298）降至0．35％（37／10466）（χ^2=97．560，P〈0．01）。男婴窒息发生率为1．43％（503／33723），明显高于女婴的0．95％（208／21834），差异有统计学意义（χ^2=22．070，P〈0．01）。产钳助产组的窒息发生率明显高于剖官产组及自然分娩组，差异有统计学意义（χ^2=114．835，P〈0．01）。早产儿窒息发生率为3．46％（70／2023），明显高于足月儿窒息发生率（1．09％，475／43314），差异有统计学意义（χ^2=90．911，P〈0．01）。自然分娩活婴中应用无痛分娩者窒息发生率为1．61％（111／6895），明显高于非无痛分娩儿的窒息发生率（1．09％，216／19749），差异有统计学意义（χ^2=11．231，P〈0．01）。在545例窒息新生儿中，引起窒息的前七位影响因素依次为胎儿窘迫、脐带异常、胎膜早破、母妊娠及内科合并症、早产、巨大儿及胎盘异常。新生儿并发症依次为肝功能受损、代谢及电解质紊乱、呼吸系统并发症、中枢神经系统损害、心肌损害、肾功能异常。结论重视新生儿窒息相关高危因素，选择合适的分娩方式，积极防治窒息后的器官功能损伤，加强新生儿窒息复苏培训及产儿合作，是降低新生儿窒息发生率和病死率的有效手段。

Retrospective analysis of 545 cases of neonatal asphyxia

Objective To investigate the incidence and risk factors of neonatal asphyxia. Methods The clinical data of 545 newborns with asphyxia from Jan.2001 to Dec. 2006 were collected. The incidence and risk factors of neonatal asphyxia were analyzed. Results The incidence of neonatal asphyxia was 1.20%.The newborn asphyxia incidence decreased from 2.13% (113/5298) in 2001 to 0.35% (37/10 466) in 2006(P<0.01). No significant difference in neonatal asphyxia incidence was found between vaginal delivery and caesarean section, but that of the forceps delivery was higher than vaginal and caesarean delivery (P<0.01) . Male infant (1.43%,503/33 723), premature delivery (3.46%,70/2023) and labor analgesia (1.61%,111/6895) had higher incidence of neonatal asphyxia than female infant (0.95%), term newborns (1.09%) and those without labor analgesia (1.09%), respectively (P<0.01) .The fires seven leading causes of organ damages were fetal distress, abnormal cord and premature rupture of membrane, maternal medical diseases, preterm birth, macrosomia and placental abnormalities. Neonatal complications included liver dysfunction, metabolic disorders, respiratory complications, central nerve system damage, cardiac damage and renal dysfunction. Conclusions Monitering the risk factors of neonatal asphyxia and preventing the organ injury may be helpful to reduce the incidence and the perinatal mortality of neonatal asphyxia, and the properly delivery way and the cooperation of the obstetrics and pediatrics were equal important.