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目的:探讨窒息新生儿并发缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)的危险因素。方法:2008年1月至2009年6月在湖南省邵阳市中心医院儿科住院的新生儿窒息患儿98例(胎龄≥37周),其中32例并发HIE。对比分析窒息新生儿并发HIE组(n=32)与窒息新生儿未并发HIE组(n=66)的围产因素。结果:并发HIE组患儿孕母不规范产前检查、脐带脱垂、胎盘早剥、男性患儿和过期产患儿均明显高于未并发HIE组(P<0.05)。体质量与1-min和5-min Apgar评分明显低于未并发HIE组(P<0.05)。HIE患儿和窒息患儿5-min Apgar评分为0~3分者病死率均明显高于5-min Apgar评分为4~7分者(P<0.05)。Logistic回归分析显示,性别、胎龄、胎盘早剥、不规范产前检查、1-min Apgar评分5个因素均为窒息新生儿并发HIE的危险因素(χ2=58.456,P=0.000)。结论:对于具有上述危险因素的窒息新生儿,应给予适当的干预和良好的新生儿复苏,可以防止围生期窒息,从而减少缺氧缺血性脑病的发生。
Objective: To explore the risk factors of neonatal asphyxia neonatoral hypoxic-ischemic encephalopathy (HIE). Methods: From January 2008 to June 2009, 98 children with neonatal asphyxia (gestational age ≥37 weeks) were admitted to Shaoyang Central Hospital, Hunan Province. 32 of them were complicated by HIE. The perinatal factors of asphyxia neonates complicated by HIE group (n = 32) and asphyxiated neonates without HIE group (n = 66) were compared. Results: The incidence of irregular prenatal maternity, umbilical cord prolapse, placental abruption, males and children with obesity in the concurrent HIE group were significantly higher than those in the non-concurrent HIE group (P <0.05). Body mass and 1-min and 5-min Apgar scores were significantly lower than those in the non-concurrent HIE group (P <0.05). Children with HIE and asphyxia children with 5-min Apgar score of 0 to 3 were significantly higher mortality than 5-min Apgar score of 4 to 7 points (P <0.05). Logistic regression analysis showed that gender, gestational age, placental abruption, irregular prenatal care and 1-min Apgar score were the risk factors of HIE in neonates with asphyxia (χ2 = 58.456, P = 0.000). Conclusion: Asphyxia neonates with these risk factors should be given appropriate interventions and good neonatal resuscitation to prevent perinatal asphyxia, thereby reducing the incidence of hypoxic-ischemic encephalopathy.