重症新生儿胎粪吸入综合征预后危险因素分析

徐倩倩; 刘彬彬; 陈雪翔; 沈怀云

doi:10.16766/j.cnki.issn.1674-4152.001722

重症新生儿胎粪吸入综合征预后危险因素分析

doi: 10.16766/j.cnki.issn.1674-4152.001722

蚌埠医学院第一附属医院儿科，安徽蚌埠 233004

基金项目:

安徽省卫生计生委科研计划项目 2016QKO44

详细信息

通讯作者:
沈怀云, E-mail: bbshenhy@163.com

中图分类号: R722.12
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- 被引次数: 0
出版历程
- 收稿日期: 2020-07-12
- 网络出版日期: 2022-02-19

Analysis of preoperative risk factors of severe neonatal meconium aspiration syndrome

Department of Pediatric, First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨影响重症胎粪吸入综合征(meconium aspiration syndrome，MAS)患儿预后的危险因素，分析这些因素的预测价值，为提高MAS的临床救治水平提供帮助。方法回顾性分析蚌埠医学院第一附属医院2014年1月—2019年12月收治的77例行机械通气治疗的重症MAS患儿的临床资料，根据治疗结果分为通气成功组和通气失败组，对2组患儿一般资料、动脉血气分析及其并发症进行比较，再对有统计学意义的观察指标进行受试者特征(ROC)曲线及多因素逐步logistic回归分析。结果 (1) 通气失败组胎儿宫内窘迫、持续性肺动脉高压(PPHN)及多器官功能障碍(MODS)发生率分别为66.7%、41.7%及66.7%，均高于通气成功组(41.5%、5.7%、22.6%)，通气失败组的Apgar评分、pH值、动脉血氧分压(PaO₂)及碱剩余(BE)均明显低于成功组，比较差异均有统计学意义(均P < 0.05)。(2)多因素logistic回归分析显示PaO₂、BE值、PPHN、MODS是影响机械通气治疗MAS预后的独立危险因素。(3)ROC曲线分析显示BE值为-8.5是预测MAS预后的最佳界值点，敏感性和特异性分别为94.3%和58.3%；PaO₂为40.5 mm Hg(1 mm Hg=0.133 kPa)是预测MAS预后的最佳界值点，敏感性和特异性分别为79.2%和58.3%。结论 PaO₂、BE值及并发症PPHN、MODS是影响机械通气治疗重症MAS患儿预后的独立危险因素，PaO₂及BE值有助于早期预测重症MAS患儿的预后，早期及时对这些危险因素采取防治措施有助于降低重症MAS的病死率。
- 胎粪吸入综合征 /
- 危险因素 /
- 预后 /
- 新生儿
Abstract: Objective To explore the risk factors affecting the prognosis of children with severe meconium inhalation syndrome (MAS), analyse the predictive value of these factors, and improve the clinical treatment level of MAS. Methods The clinical data of 77 patients with severe MAS treated by mechanical ventilation from January 2014 to December 2019 were retrospectively analysed. According to the treatment results, the patients were divided into successful ventilation group and failure ventilation group. The general data, arterial blood gas analysis and their complications were compared between the two groups. Receiver characteristic (ROC) curve and stepwise logistic regression were used to analyse the statistically significant observation indexes. Results (1) The incidence of intrauterine distress, persistent pulmonary hypertension (PPHN) and multiple organ dysfunction (MODS) in the failure ventilation group was 66.7%, 41.7% and 66.7%, respectively, which were higher than those in the successful ventilation group (41.5%, 5.7% and 22.6%). The Apgar score, pH value, arterial partial pressure of oxygen (PaO₂) and buffer excess (BE) in the failure ventilation group were significantly lower than those in the successful ventilation group. The difference was statistically significant (all P < 0.05). (2) Multivariate logistic regression analysis showed that PaO₂, BE value, PPHN and MODS were independent risk factors of mechanical ventilation in the treatment of MAS. (3) ROC curve analysis showed that the BE value of -8.5 was the suitable boundary point to predict MAS prognosis, and the sensitivity and specificity were 94.3% and 58.3%, respectively; its PaO₂ was 40.5 mm Hg, which was the best boundary point to predict prognosis, and the sensitivity and specificity were 79.2% and 58.3%, respectively. Conclusion PaO₂ BE values and combined PPHN and MODS are the independent risk factors affecting the prognosis of MAS after mechanical ventilation. BE values and PaO₂ can predict the prognosis of children with MAS, and early and timely prevention and treatment of these risk factors can reduce the mortality of severe MAS.
- Meconium aspiration syndrome /
- Risk factors /
- Prognosis /
- Neonatus

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图 1 BE值、PaO₂对预测MAS预后的ROC曲线

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表 1 2组MAS患儿临床资料比较(x±s)

组别	例数	入院日龄[M(P₂₅, P₇₅), h]	胎龄(周)	出生体重(g)	性别[例(%)]		剖宫产[例(%)]	宫内窘迫[例(%)]
组别	例数	入院日龄[M(P₂₅, P₇₅), h]	胎龄(周)	出生体重(g)	男	女	剖宫产[例(%)]	宫内窘迫[例(%)]
成功组	53	3(1.5，6.0)	39.5±1.4	3 202±609	32(60.4)	21(39.6)	28(52.8)	22(41.5)
失败组	24	4(2.0，10.5)	39.8±1.7	3 307±538	14(58.3)	10(41.7)	12(50.0)	16(66.7)
统计值		-0.924^a	-0.877^b	-0.722^b	0.029^c		0.053^c	4.183^c
P值		0.355	0.383	0.437	0.865		0.818	0.041

组别	例数	pH值	PaCO₂(mm Hg)	PaO₂(mm Hg)	BE值		Apgar 1 min评分(分)	Apgar 5 min评分(分)
成功组	53	7.2±0.1	51.8±13.3	53.6±19.0	-5.2±2.8		7±1	7±1
失败组	24	7.1±0.2	54.8±15.4	40.0±16.6	-9.7±7.2		5±2	8±1
统计值		2.337^b	-0.889^b	3.012^b	-2.994^b		-3.789^b	-3.935^b
P值		0.026	0.377	0.004	0.003		< 0.001	< 0.001
注：^a为Z值，^b为t值，^c为χ²值。

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表 2 2组MAS患儿并发症比较[例(%)]

组别	例数	HIE	NRDS	PPHN	MODS	NPH
成功组	53	45(84.9)	38(71.7)	3(5.7)	12(22.6)	0(0)
失败组	24	23(95.8)	22(91.7)	10(41.7)	16(66.7)	2(8.3)
χ²值		0.999	3.829	12.804	13.836	1.839
P值		0.318	0.050	< 0.001	< 0.001	0.175

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表 3 多因素logistic回归赋值表

自变量	赋值
治疗结果	0=失败，1=成功
Apgar 1 min	定量
Apgar 5 min	定量
pH值	定量
BE值	定量
PaO₂	定量
PPHN	0=有，1=无
MODS	0=有，1=无

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表 4 影响MAS预后的多因素逐步logistic回归分析

项目	B	SE	Wald χ²	P值	OR值	95%CI
Apgar 1 min	0.146	0.529	0.077	0.782	1.158	0.411~3.263
Apgar 5 min	-1.304	0.742	3.087	0.079	0.271	0.063~1.163
PH值	-6.533	4.892	1.783	0.182	0.001	< 0.001~21.238
BE值	-0.289	0.144	4.045	0.044	0.749	0.565~0.993
PaO₂	-0.133	0.058	5.256	0.022	0.875	0.781~0.981
PPHN	3.753	1.673	5.260	0.022	42.670	1.726~1 054.833
MODS	2.951	1.429	4.264	0.039	19.133	1.162~315.052

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表 5 患儿BE值及PaO₂对MAS预后的预测价值分析

项目	临界值	灵敏度(%)	特异度(%)	AUC	P值	95% CI
BE	-8.5	94.3	58.3	0.713	0.003	0.558~0.867
PaO₂	40.5	79.2	58.3	0.726	0.002	0.559~0.853

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