宫内窘迫新生儿发生缺氧缺血性脑病的 危险因素分析

Investigation on risk factors of neonatal hypoxic ischemic encephalopathy

摘要:

目的 研究具有宫内窘迫暴露因素的新生儿发生缺氧缺血性脑病（HIE）的危险因素。方法 收 集2016 年6 月—2018 年3 月于佳木斯大学附属第一医院收治的具有宫内窘迫暴露因素，但尚未确诊为 HIE 的患儿作为病例组。选取同一居住区、性别比例、民族、年龄相差3 个月左右且未罹患HIE 儿童作 为对照组，对两组临床资料进行Logistic 回归分析。结果 单因素Logistic 回归分析结果显示，县镇医院分 娩、母亲文化程度低（小学及以下）、居室周围环境差、早产（孕周<37 周）、分娩时异常、出生体重低 （<2 500 g）、孕期及新生儿各因素比较，差异有统计学意义（P <0.05）。多因素Logistic 回归分析结果显示， 出生体重低<2 500 g[Ol ^ R=9.268（95% CI ：1.765，30.908），P =0.005]、孕周<37 周[Ol ^ R=16.036（95% CI ： 5.906，49.133），P=0.005]、母亲文化程度低[Ol ^ R=2.392（95% CI ：1.202，4.961），P =0.000]、新生儿肌张力 高[Ol ^ R=14.160（95% CI ：5.436，36.680），P =0.027] 及新生儿出生窒息[Ol ^ R=14.051（95% CI ：1.575，125.361）， P =0.006] 是HIE 发病的影响因素。结论 孕期和围产期危险因素与宫内窘迫有协同作用，增加HIE 发病风险。

Abstract:

Objective To investigate the risk factors for hypoxic ischemic encephalopathy (HIE) in neonates with intrauterine distress exposure. Methods Children with intrauterine distress exposure, who had not been diagnosed with HIE, were enrolled in the First Affiliated Hospital of Jiamusi University from June 2016 to March 2018. According to the same living area, the same sex, the same ethnic group and 3-month different age, the children who have not suffered from HIE are selected. The data of two groups were analyzed by Logistic analysis. Results Univariate logistic regression analysis showed that there were significant differences in factors such as delivery in county hospitals, low educational level of mothers (primary school and below), poor living environment, premature delivery (gestational weeks < 37 weeks), abnormal delivery, low birth weight (< 2500 g), pregnancy and neonatal (P < 0.05). The multivariate logistic regression analysis showed influencing factors of HIE, such as low birth weight (P = 0.005, Ol ^ R=9.268, 95% CI=1.765, 30.908), premature birth (P = 0.005, Ol ^ R=16.036, 95% CI=5.906, 49.133), low maternal education (P = 0.0003, Ol ^ R=2.392, 95% CI=1.202, 4.961), high muscle tone (P = 0.027, Ol ^ R=14.160, 95% CI=5.436, 36.680) and neonatal asphyxia (P = 0.006, Ol ^ R=14.051, 95% CI=1.575, 125.361). Conclusions The risk factors of pregnancy and perinatal period and intrauterine distress synergy increase the risk of HIE.