【摘要】：目的分析新生兒重度缺氧缺血性腦病(HIE)的臨床特點及隨訪情況,為合理診治及隨訪提供依據(jù)。方法選擇2011年1月至2014年10月我院足月新生兒病房收治的重度HIE患兒臨床資料進行回顧性分析,總結(jié)患兒一般資料、輔助檢查、治療、轉(zhuǎn)歸、隨訪和預(yù)后情況,對影響患兒預(yù)后的因素進行多元Logistic回歸分析。結(jié)果共納入123例重度HIE患兒,除常規(guī)治療外,6例予亞低溫治療,21例予高壓氧治療,治療好轉(zhuǎn)60例,放棄治療55例,住院死亡8例。單因素分析顯示5 min Apgar評分、驚厥、昏迷、p H、BE、臟器損傷、亞低溫治療是影響重度HIE患兒預(yù)后的危險因素;多因素分析顯示5 min Apgar評分3分(OR=4.071,95%CI 1.309~15.613)、BE≤-10 mmol/L(OR=36.810,95%CI 5.913~41.119)是影響重度HIE患兒預(yù)后的獨立危險因素(P0.05),入院日齡72 h(OR=0.096,95%CI 0.026~0.353)是影響重度HIE患兒預(yù)后的保護性因素。重度HIE患兒易合并臟器損傷和電解質(zhì)紊亂,其中臟器損傷以腦、肺、心損傷最常見,電解質(zhì)紊亂以低鈣、低鈉多見。123例患兒中,33例失訪,49例死亡(8例住院期間死亡,41例放棄治療后死亡),死亡原因前五位分別為因經(jīng)濟因素及擔心后遺癥放棄治療(20例)、多臟器功能損傷(16例)、氣胸(4例)、彌散性血管內(nèi)凝血(6例)、休克(3例)。41例存活患兒進行9~54個月隨訪,5例繼發(fā)腦癱,3例繼發(fā)癲疒間;7例發(fā)育大致正常;其余26例發(fā)育落后于同齡患兒。結(jié)論重度HIE患兒病死率高,合并癥多,留有后遺癥比率高。及時發(fā)現(xiàn)危險因素是預(yù)防重度HIE的關(guān)鍵,對重度HIE更遠期預(yù)后的隨訪工作需積極開展。
[Abstract]:Objective to analyze the clinical features and follow-up of severe hypoxic ischemic encephalopathy (HIE) in neonates. Methods the clinical data of severe HIE patients admitted to our hospital from January 2011 to October 2014 were retrospectively analyzed. The general data, auxiliary examination, treatment, outcome, follow-up and prognosis were summarized. Multivariate Logistic regression analysis was used to analyze the prognostic factors of children. Results A total of 123 children with severe HIE received mild hypothermia treatment in 6 cases, hyperbaric oxygen therapy in 21 cases, improvement in 60 cases, abandonment in 55 cases and hospital death in 8 cases. Univariate analysis showed that 5 min Apgar score, convulsion, coma, pHG, organ injury and mild hypothermia therapy were risk factors for prognosis of severe HIE patients. Multivariate analysis showed that the 5 min Apgar score (OR=4.071,95%CI 1.309 鹵15.613), BE 鈮，

本文編號：2291495