重度新生儿呼吸窘迫综合征死亡危险因素分析

目的探讨重度新生儿呼吸窘迫综合征（respiratory distress syndrome，RDS）导致死亡的主要危险因素。方法回顾性分析2010年1月至2011年12月我院NICU诊断为重度RDS的66例早产儿的病例资料。按患儿结局分为死亡组和存活组进行分析。结果重度RDS死亡24例，病死率36．36％。死亡组患儿机械通气时间、碱剩余中位数、pH最小值、PaO2／FiO2最小值、平均胎龄、平均出生体重、1min Apgar评分、5min Apgar评分均低于存活组（P均〈0．05）。死亡组机械通气FiO2〉60％时间中位数、合并宫内窘迫比例、多胎比例、新生儿急性生理学评分围生期补充-Ⅱ（sore for neonatal acute physiology perinatal extension versionⅡ，SNAPPE-Ⅱ）均高于存活组（P均〈0．05），两组机械通气并发症比较差异无统计学意义（P〉0．05）。对相关变量行Logistic回归分析，重度RDS死亡独立危险因素为出生体重、1minApgar评分和SNAPPE-Ⅱ评分，OR值为0．990、0．141和1．240。对SNAPPE—II评分进行受试者工作特征曲线分析，曲线下面积为0．86，与0．5相比差异有统计学意义（P=0．000）。分界点SNAPPE-Ⅱ评分=24．50时对应的正确预测指数最大（Youden指数=0．70）。结论重度RDS死亡独立危险因素为出生体重、1minApgar评分和SNAPPE—Ⅱ评分；SNAPPE-Ⅱ评分对重度RDS死亡风险预测准确性中等，其为24．50时预测准确性最大。

Risk factors of death from severe neonatal respiratory distress syndrome

Objective To explore the death risk factors of preterm infants with respiratory distress syndrome （RDS）. Methods A retrospective analysis of 66 preterm infants with severe RDS, who admitted to our NICU between January 2010 and December 2011. The patients were divided into the death group and survival group according to the ending. Results There were a total of 24 cases died （36. 36% ）. The death group＇s mechanical ventilation time, the median of base excess, the minimum median of pH,PaO2/FiO2, average gestational age, average birth weight, 1 minute Apgar score and 5 minute Apgar score were all lower than those of survival group （P 〈 0. 05 ）. In death group, the median duration of FiO2 〉 60%, intrauterine distress, polyembryony, sore for neonatal acute physiology perinatal extension version Ⅱ （ SNAPPE- Ⅱ ） score were all higher than those of survival group （ P 〈 0. 05）, but the mechanical ventilation complications had no difference between the two groups （ P 〉 0. 05 ）. Further Logistic regression analysis showed that independent risk factors were birth weight, 1 minute Apgar score and SNAPPE-Ⅱ score, OR were 0. 990,0. 141 and 1.240 respectively. Receiver operating characteristic analysis of the ability of SNAPPE- Ⅱ score predicting death risk showed the area under curve was 0. 86, the difference was statistically significant compared with 0. 5 （ P = 0. 000）. Death risk prediction showed that the demarcation point SNAPPE-Ⅱ score = 24. 50 corresponded to the maximum （ Youden index =0. 70） correct prediction effect. Conclusion Independent risk factors of died from severe RDS are birth weight, 1 minute Apgar score and SNAPPE-Ⅱ scores; SNAPPE-Ⅱ score predicts risk of death from severe RDS accuracy is medium,equal to 24. 50 is the best accuracy to the death risk prediction.