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目的探讨极低出生体重儿(VLBW)近期预后的疾病及其危险因素和保护因素。方法总结重庆医科大学附属儿童医院2001年6月至2010年2月收治的475例符合纳入标准的VLBW患儿临床资料,找出对近期预后有显著影响的疾病。对这些疾病行单因素分析,将单因素分析中差异有统计学意义的变量代入logistic回归模型分析。结果近期预后良好339例(71.37%);近期预后不良136例(28.62%),两组中差异有统计学意义的疾病是新生儿呼吸窘迫综合征(NRDS)[11.8%(40例)vs38.2%(52例),χ2=43.434,P=0.000]、肺出血[2.9%(10例)vs25.0%(34例),χ2=56.147,P=0.000]。NRDS的危险因素为低出生体重(OR=6.368,P=0.000)、小于胎龄儿(OR=5.806,P=0.000)、有窒息史(OR=2.087,P=0.006)、产前未用地塞米松(OR=1.948,P=0.014);NRDS的保护因素为胎膜早破(OR=0.419,P=0.004)。肺出血的危险因素为NRDS(OR=10.473,P=0.002)、硬肿(OR=2.265,P=0.027);肺出血的保护因素为胎膜早破(OR=0.167,P=0.013)。结论 NRDS、肺出血是影响VLBW近期预后的重要疾病。
Objective To investigate the recent prognosis of very low birth weight infants (VLBW) and their risk factors and protective factors. Methods The clinical data of 475 children with VLBW who met the inclusion criteria from June 2001 to February 2010 in Children’s Hospital of Chongqing Medical University were summarized, and the diseases that had a significant effect on the short-term prognosis were identified. Univariate analysis of these diseases, the univariate analysis of statistically significant difference between the variables into the logistic regression model analysis. Results The recent prognosis was 339 (71.37%). The recent poor prognosis was 136 (28.62%). There was a statistically significant difference between the two groups in neonatal respiratory distress syndrome (NRDS) [11.8% (40) vs38). 2 (52 cases), χ2 = 43.434, P = 0.000], pulmonary hemorrhage (2.9% (10 cases) vs 25.0% (34 cases), χ2 = 56.147, P = 0.000]. The risk factors of NRDS were as follows: low birth weight (OR = 6.368, P = 0.000), less gestational age (OR = 5.806, P = 0.000), history of asphyxia (OR = 2.087, P = 0.006) (OR = 1.948, P = 0.014). The protective factor of NRDS was premature rupture of membranes (OR = 0.419, P = 0.004). The risk factors of pulmonary hemorrhage were NRDS (OR = 10.473, P = 0.002), edema (OR = 2.265, P = 0.027). Premature rupture of membranes (OR = 0.167, P = 0.013) was the protective factor of pulmonary hemorrhage. Conclusion NRDS and pulmonary hemorrhage are important diseases that affect the short-term prognosis of VLBW.