摘要
目的分析影响胎龄<34周早产儿发生新生儿呼吸窘迫综合征(NRDS)的危险因素。方法收集2019年1月至2022年1月在绵阳市中心医院分娩的324例胎龄<34周的早产儿及其母亲的临床资料,根据是否发生NRDS分为NRDS组和非NRDS组。比较两组早产儿及其母亲的相关临床资料,采用多因素Logistic回归分析影响NRDS发生的高危因素。结果在324例胎龄<34周早产儿中,169例发生NRDS,155例未发生NRDS,NRDS发生率为52.16%。两组早产儿性别比较差异无统计学意义(P>0.05),NRDS组胎龄<32周早产儿占比高于非NRDS组[67.46%(114/169)比55.48%(86/155)](P<0.05),但NRDS组早产儿出生时体质量低于非NRDS组[(1113±168)g比(1345±196)g](P<0.01)。两组母体年龄、产时体质量指数、产次情况以及妊娠期甲状腺功能减退、不良孕产史、产道畸形占比情况比较差异无统计学意义(P>0.05)。NRDS组母体有妊娠期高血压、妊娠期糖尿病、阴道炎病史者占比高于非NRDS组[52.66%(89/169)比41.29%(64/155)、50.89%(86/169)比36.77%(57/155)、32.54%(55/169)比20.65%(32/155)](P<0.05),但产前使用糖皮质激素占比低于非NRDS组[63.91%(108/169)比80.65%(125/155)](P<0.01)。NRDS组发生胎膜早破、胎儿宫内窘迫、宫内感染、羊水污染比例高于非NRDS组[62.72%(106/169)比45.81%(71/155)、70.41%(119/169)比52.26%(81/155)、69.23%(117/169)比41.94%(65/155)、70.41%(119/169)比46.45%(72/155)](P<0.01),但阴道分娩的占比低于非NRDS组[26.63%(45/169)比49.68%(77/155)](P<0.01)。Logistic回归分析结果显示,胎龄<32周、妊娠糖尿病、胎儿宫内窘迫、宫内感染是导致NRDS发生的独立高危因素(OR=2.198,95%CI 1.157~4.176;OR=1.947,95%CI 1.040~3.645;OR=1.986,95%CI 1.068~3.693;OR=3.868,95%CI 2.097~7.138)(均P<0.05),胎儿出生高体质量、产前使用糖皮质激素是NRDS发生的保护因素(OR=0.994,95%CI 0.992~0.995;OR=0.506,95%CI 0.263~0.975,P<0.05)。结论胎龄<32周、胎儿宫内窘迫、宫内感染、母体患有妊娠糖尿病是胎龄<34周早产儿发生NRDS的危险因素,胎儿出生时高体质量、产前使用糖皮质激素是胎龄<34周早产儿发生NRDS的保护因素。
Objective To analyze the risk factors of neonatal respiratory distress syndrome(NRDS)in preterm infants with gestational age<34 weeks.Methods The clinical data of 324 premature infants with gestational age<34 weeks and their mothers who gave birth at Mianyang Central Hospital from Jan.2019 to Jan.2022 was collected,and they were divided into a NRDS group and a non-NRDS group based on the occurrence of NRDS.The relevant clinical data of the two groups of premature infants and their mothers was compared,and multivariate logistic regression analysis was used to identify high-risk factors affecting the occurrence of NRDS.Results Among the 324 preterm infants,169 had NRDS and 155 had no NRDS,the incidence of NRDS was 52.16%.There was no significant difference in gender between the two groups(P>0.05).The proportion of preterm infants with gestational age<32 weeks in the NRDS group was higher than that in the non-NRDS group[67.46%(114/169)vs 55.48%(86/155)](P<0.05);the body mass at birth in the NRDS group was lower than that in the non-NRDS group[(1113±168)g vs(1345±196)g](P<0.01).There were no significant differences in maternal age,intrapartum body mass index,delivery times,and the proportion of hypothyroidism during pregnancy,adverse pregnancy and birth canal malformations between the two groups(P>0.05).The proportions of maternal history of gestational hypertension,gestational diabetes and vaginitis in the NRDS group were higher than those in the non-NRDS group[52.66%(89/169)vs 41.29%(64/155),50.89%(86/169)vs 36.77%(57/155),32.54%(55/169)vs 20.65%(32/155)](P<0.05),but the proportion of prenatal glucocorticoid use was lower than that of the non-NRDS group[63.91%(108/169)vs 80.65%(125/155)](P<0.01).The incidences of premature rupture of membranes,fetal intrauterine distress,intrauterine infection and amniotic fluid contamination in the NRDS group were higher than those in the non-NRDS group[62.72%(106/169)vs 45.81%(71/155),70.41%(119/169)vs 52.26%(81/155),69.23%(117/169)vs 41.94%(65/155),70.41%(119/169)vs 46.45%(72/155)](P<0.01),but the proportion of vaginal delivery was lower than that of the non-NRDS group[26.63%(45/169)vs 49.68%(77/155)](P<0.01).Logistic regression analysis showed that gestational age<32 weeks,gestational diabetes,fetal intrauterine distress and intrauterine infection were independent risk factors for NRDS(OR=2.198,95%CI 1.157-4.176;OR=1.947,95%CI 1.040-3.645;OR=1.986,95%CI 1.068-3.693;OR=3.868,95%CI 2.097-7.138)(all P<0.05),high fetal birth weight and prenatal glucocorticoid use was a protective factor for NRDS(OR=0.994,95%CI 0.992-0.995;OR=0.506,95%CI 0.263-0.975,P<0.05).Conclusion Gestational age<32 weeks,fetal intrauterine distress,intrauterine infection and maternal gestational diabetes are risk factors for NRDS in preterm infants<34 weeks,high fetal birth weight,and prenatal glucocorticoid use is a protective factor.
作者
薛丹
陈佳
XUE Dan;CHEN Jia(Department of Neonatology,Mianyang Central Hospital,Mianyang 621000,China)
出处
《医学综述》
CAS
2023年第20期4399-4403,F0003,共6页
Medical Recapitulate
关键词
新生儿呼吸窘迫综合征
胎龄<34周
早产儿
危险因素
Neonatal respiratory distress syndrome
Gestational age<34 weeks
Preterm infants
Risk factors
