102例不同时期缺氧新生儿缺氧缺血性脑病临床预后分析

目的:分析不同时期缺氧所致新生儿缺氧缺血性脑病(HIE) 的病因和预后, 探讨改善预后的措施。方法: 对102例HIE患儿围产期病因及干预措施进行分析。结果: 胎儿期缺氧所致67例, 其中轻度HIE18例, 中度HIE19例, 重度HIE30例; 共存活57例, 死亡10例。产时产后缺氧所致35例, 其中轻度HIE23例, 中度HIE7例, 重度HIE5例; 共存活34例, 死亡1例。胎儿期缺氧中、重度HIE较产时产后缺氧发生率高, 预后差, 死亡率高, 差异显著(P<0 .05); 维持血糖在正常高值预后明显优于血糖在正常低值及正常中值水平, 均有显著差异(P<0.05); 而血糖在正常中值者的预后与血糖在正常低值者的预后无显著差异(P>0 .05)。结论: 胎儿期缺氧中、重度HIE发生率高; 胎儿期缺氧和血糖在正常中、低值水平患儿预后均差, 死亡率高。及早给予“三维持、三控制”尤其维持血糖在正常高值, 是提高HIE患儿抢救成功率及改善预后的重要措施。

Clinical analysis on prognosis of 102 neonates with hypoxic ischemic encephalopathy induced by hypoxia at different periods

Objective:To analyze the pathogeny and prognosis of neonates with hypoxic ischemic encephalopathy (HIE) induced by hypoxia at different periods and explore its countermeasures. Methods:The pathogeny and intervention of 102 children with HIE were analyzed. Results:Of 67 cases induced by hypoxia at fetal period, 18 cases with mild HIE, 19 cases with moderate HIE and 30 cases with severe HIE; 57 cases survived, and 10 cases died. Of 35 cases induced by postpartum hypoxia at delivery, 23 cases with mild HIE, 7 cases with moderate HIE and 5 cases with severe HIE; 34 cases survived, 1 case died. There were the higher incidence and higher mortality in moderate and severe HIE induced by hypoxia at fetal period comparing to those at delivery ( P <0.05). The prognosis of blood sugar at normal high value was better than those at normal low value and median ( P <0.05). There was no significant difference in prognosis between blood sugar at normal median and normal low value ( P >0.05).Conclusion:There were the higher incidence of moderate and severe HIE in fetal period, and the prognosis of children with HIE were poor with the higher mortality when their blood sugar at normal median or low value induced by hypoxia at fetal period.“Three management and three controls” being given timely, especially blood sugar kept at normal high value, should be the important measures of promoting success rate of salvage and improving their prognosis.