摘要目的:探究影响重度新生儿缺氧缺血性脑病(HIE)预后的相关因素。方法:选取2016年1月至2019年4月本院诊治的重度HIE患儿134例为研究对象,均随访6个月,无失访病例。根据预后情况将患儿分为预后良好组、预后不良组,收集患儿临床资料,采用单因素及多因素Logistic回归法分析重度HIE患儿预后的影响因素。结果:随访结果统计显示,预后良好103例(76.87%),预后不良31例(23.13%);预后不良组中包括4例死亡,占比2.99%。单因素分析显示,重度HIE预后良好组与预后不良组患儿的5 min Apgar评分、脏器损伤、开始治疗日龄、血清tau蛋白水平比较差异有统计学意义(P<0.05);而性别、胎龄、出生体重、分娩方式、1 min Apgar评分比较差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,5 min Apgar评分≤3分(OR=58.658,95% CI=6.984~492.682)、脏器损伤≥2个(OR=31.145,95% CI=3.522~275.415)、开始治疗日龄≥48h(OR=33.747,95% CI=5.992~190.066)、血清tau蛋白≥8ng/L(OR=5.846,95% CI=1.372~24.918)是影响重度HIE患儿预后的危险因素(均P<0.05)。结论:5 min Apgar评分≤3分、脏器损伤≥2个、开始治疗日龄≥48h、血清tau蛋白≥8ng/L的重度HIE患儿发生预后不良的危险性更高,临床应加强针对性监护与及时干预。
Abstract：Objective: To explore the related factors that affected the prognosis of severe hypoxic-ischemic encephalopathy (HIE). Methods: A total of 134 children with severe HIE who were treated in our hospital from January 2016 to April 2019 were enrolled. All patients were followed up for 6 months without any loss of follow-up. According to the prognosis, the children were divided into a good prognosis group and a poor prognosis group. The clinical data of the children were collected. The factors affecting the prognosis of children with severe HIE were analyzed by single factor and multivariate logistic regression. Results: The follow-up results showed that the prognosis was good in 103 cases (76.87%), and the prognosis was poor in 31 cases (23.13%). The prognosis group included 4 deaths, accounting for 2.99%.Univariate analysis showed that the 5 min Apgar score, organ injury, starting treatment age, and serum tau protein levels were significantly different between the patients with severe HIE prognosis and those with poor prognosis (P<0.05). There was no significant difference in gestational age, birth weight, mode of delivery, and 1 min Apgar score (P>0.05).Multivariate logistic regression analysis showed that 5 min Apgar score ≤ 3 points (OR=58.658, 95% CI=6.984~492.682), organ damage ≥ 2 (OR=31.145, 95%CI=3.522~275.415), starting treatment Age≥48h (OR=33.747, 95% CI=5.992~190.066), serum tau ≥8ng/L (OR=5.846, 95% CI=1.372~24.918) are risk factors for the prognosis of children with severe HIE (all P<0.05). Conclusion: Patients with 5 min Apgar score ≤ 3, organ injury ≥ 2, age ≥ 48h, and serum tau protein ≥ 8ng / l have a higher risk of poor prognosis. Therefore, clinical monitoring and timely intervention should be strengthened.
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2020, Vol. 26 
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