目的分析新生儿重度缺氧缺血性脑病(HIE)的临床特点及随访情况,为合理诊治及随访提供依据。方法选择2011年1月至2014年10月我院足月新生儿病房收治的重度HIE患儿临床资料进行回顾性分析,总结患儿一般资料、辅助检查、治疗、转归、随访和预后情况,对影响患儿预后的因素进行多元Logistic回归分析。结果共纳入123例重度HIE患儿,除常规治疗外,6例予亚低温治疗,21例予高压氧治疗,治疗好转60例,放弃治疗55例,住院死亡8例。单因素分析显示5 min Apgar评分、惊厥、昏迷、p H、BE、脏器损伤、亚低温治疗是影响重度HIE患儿预后的危险因素;多因素分析显示5 min Apgar评分<3分(OR=4.071,95%CI 1.309~15.613)、BE≤-10 mmol/L(OR=36.810,95%CI 5.913~41.119)是影响重度HIE患儿预后的独立危险因素(P<0.05),入院日龄<72 h(OR=0.096,95%CI 0.026~0.353)是影响重度HIE患儿预后的保护性因素。重度HIE患儿易合并脏器损伤和电解质紊乱,其中脏器损伤以脑、肺、心损伤最常见,电解质紊乱以低钙、低钠多见。123例患儿中,33例失访,49例死亡(8例住院期间死亡,41例放弃治疗后死亡),死亡原因前五位分别为因经济因素及担心后遗症放弃治疗(20例)、多脏器功能损伤(16例)、气胸(4例)、弥散性血管内凝血(6例)、休克(3例)。41例存活患儿进行9~54个月随访,5例继发脑瘫,3例继发癫疒间;7例发育大致正常;其余26例发育落后于同龄患儿。结论重度HIE患儿病死率高,合并症多,留有后遗症比率高。及时发现危险因素是预防重度HIE的关键,对重度HIE更远期预后的随访工作需积极开展。 Objective To analyze the clinical features and follow-up of neonates with severe hypoxic-ischemic encephalopathy (HIE) and provide the basis for reasonable diagnosis and follow-up. Methods The clinical data of severe HIE children admitted to our hospital from January 2011 to October 2014 were analyzed retrospectively. The general information, auxiliary examination, treatment, outcome, follow-up and prognosis were summarized. Multivariate logistic regression analysis was performed on the factors affecting the prognosis of children. Results A total of 123 children with severe HIE were enrolled in this study. Six of them were treated with hypothermia, and 21 were treated with hyperbaric oxygenation. Sixty patients were cured, 55 were given up and 8 were hospitalized. Univariate analysis showed that 5 min Apgar score, convulsion, coma, p H, BE, organ injury and mild hypothermia were the risk factors influencing the prognosis of severe HIE. Multivariate analysis showed that the Apgar score at 5 min was <3 (OR = (OR = 36.810, 95% CI 5.913 ~ 41.119) were independent risk factors for the prognosis of children with severe HIE (P <0.05) 72 h (OR = 0.096, 95% CI 0.026 ~ 0.353) was a protective factor affecting the prognosis of children with severe HIE. Severe HIE complicated with organ damage and electrolyte imbalance in children, including organ damage in the brain, lung, heart injury most common, electrolyte imbalance to calcium, sodium more common. Of the 123 children, 33 were lost to follow-up, 49 died (8 died during hospitalization and 41 died after giving up treatment). The top five causes of death were the abandonment of treatment due to economic factors and sequelae (20), respectively Impaired organ function (16 cases), pneumothorax (4 cases), disseminated intravascular coagulation (6 cases) and shock (3 cases). 41 surviving children were followed up for 9-54 months, 5 cases had secondary cerebral palsy and 3 cases had secondary epilepsy. The development of 7 cases was generally normal. The remaining 26 cases lagged behind their peers. Conclusion Severe HIE children with high mortality, complications, leaving a high proportion of sequelae. Timely detection of risk factors is the key to prevent severe HIE, the prognosis of more advanced HIE follow-up should be actively carried out.