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目的:探讨新生儿缺氧缺血性脑病(HIE)预后的相关因素,加强临床防治的有效性和针对性。方法:采用病例对照研究方法,对142例HIE患儿的临床资料进行研究,详细记录患儿人口学因素、分娩情况、急性期症状表现、临床分度、CT分度等指标,随访死亡例数,以Gesell发育量表为测评标尺在(2.0±0.1)岁时进行运动神经发育商评分,匹配同期出生正常儿童30名作为参照。死亡和发育异常者为预后不良组,发育正常者为预后良好组,采用Logistic回归比较两组的暴露因素。结果:单因素分析显示:两组急性期临床分度、CT分度、出生10分钟Apgar评分、严重强直性惊厥、脑干症状、昏迷超过1周、反复呼吸暂停、中枢性呼吸衰竭、分娩医院的级别、早期智能干预存在显著统计学意义(P<0.01或P<0.05);多元Lo-gistic回归分析显示:CT分度、昏迷超过1周、中枢性呼吸衰竭、早期智能干预、出生10分钟Apgar评分≥7分患儿的OR值分别是2.764、3.482、3.714、0.376和0.315(P<0.05)。结论:CT分度、昏迷、中枢性呼吸衰竭、智能干预时间、出生10分钟Apgar评分是影响HIE预后的独立因素,对HIE患儿预后评估和临床治疗方案制定应充分考虑以上因素,最大限度地促进患儿健康发育。
Objective: To explore the prognosis of neonatal hypoxic-ischemic encephalopathy (HIE) related factors, to enhance the effectiveness of clinical prevention and targeted. Methods: A case-control study was conducted to investigate the clinical data of 142 HIE children. The demographic factors, delivery status, symptom manifestations, clinical index and CT index were recorded in detail. The number of deaths were followed up , And the Gesell developmental scale was used as the evaluation scale to score motor neuroneointegrators at the age of (2.0 ± 0.1) years, matching 30 normal children born in the same period for reference. Those with abnormal death and development were in poor prognosis group and those with normal development were in good prognosis group. Logistic regression was used to compare the exposure factors between the two groups. Results: Univariate analysis showed that the clinical scores, CT scores, 10-minute Apgar score, severe tonic convulsions, brainstem symptoms, coma over 1 week, repeated apnea, central respiratory failure, delivery hospital (P <0.01 or P <0.05). Multivariate Lo-gistic regression analysis showed that CT index, coma more than 1 week, central respiratory failure, early intelligence intervention, 10 minutes of birth The OR of children with Apgar score≥7 was 2.764, 3.482, 3.714, 0.376 and 0.315 respectively (P <0.05). Conclusions: Apgar score, CT index, coma, central respiratory failure, intelligent intervention time and 10 minutes after birth are independent prognostic factors for HIE. The prognostic assessment and clinical treatment plan should be fully considered in the development of HIE and the maximum Promote the healthy development of children.