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目的了解重庆市出生窒息死亡新生儿的流行病学特征及城乡差异,提出降低出生窒息病死率的干预措施。方法根据《重庆市5岁以下儿童死亡监测方案》,采用城乡分层整群抽样的方法,对全市2005-2008年5岁以下儿童死亡监测中的326例出生窒息死亡案例进行统计分析。结果重庆市新生儿出生窒息死因别病死率为151.11/10万,乡村户籍新生儿出生窒息死因别病死率显著高于城镇(χ2=18.79,P<0.01),死亡时间早于城镇:24 h内死亡的乡村新生儿比例显著高于城镇(79.55%vs65.33%,χ2=8.30,P<0.01);1～7 d内死亡的城镇新生儿比例(31.33%)与乡村(19.32%)比较有统计学差异(χ2=6.26,P<0.01);乡村新生儿死前未治疗比例为30.86%,是城镇(9.93%)的3.1倍,死前住院治疗比例(46.29%)显著低于城镇(78.81%,P<0.05),死前诊断级别主要在乡镇医院(30.68%)及村诊所(26.14%)。结论新生儿窒息是我市新生儿死亡首位原因,近年来呈逐渐下降趋势,但存在乡村新生儿病死率较高和死前医疗保健不足等问题。加强基层产儿科基础建设,提高高危妊娠的识别、产程处理及复苏技巧能力,推广新法窒息复苏技术培训,对不具备条件的地方开展胎儿腹中转运等是降低新生儿出生窒息病死率的有效措施。
Objective To understand the epidemiological characteristics and urban-rural differences of neonates with asphyxia at birth in Chongqing and to propose interventions to reduce the mortality rate of asphyxial birth. Methods According to “Chongqing Children Under 5 Years Survival Monitoring Program”, a statistical analysis of 326 cases of asphyxial death among children under 5 years of age in Chongqing from 2005 to 2008 was conducted by stratified cluster sampling method in urban and rural areas. Results The case fatality rate of newborns in Chongqing was 151.11 / 100000. The mortality rate of newborns in rural areas was significantly higher than that of urban ones (χ2 = 18.79, P <0.01). The death rate was earlier than that of urban areas within 24 hours (79.55% vs65.33%, χ2 = 8.30, P <0.01). The proportion of newborns in cities and towns born within 1 ~ 7 days (31.33%) was significantly higher than that in rural areas (19.32%) (Χ2 = 6.26, P <0.01). The proportion of untreated newborns in rural areas was 30.86%, 3.1 times that of urban areas (9.93%), and the hospitalization rate before death was 46.29%, significantly lower than that of urban areas (78.81%) %, P <0.05). The diagnostic level before death was mainly in township hospitals (30.68%) and village clinics (26.14%). Conclusions Neonatal asphyxia is the first cause of neonatal death in our city, which shows a gradual downward trend in recent years. However, there are some problems such as high mortality rate of newborn in rural areas and inadequate medical care before death. Strengthening basic infrastructure for pediatric pediatrics, improving the identification of high-risk pregnancies, skills in labor treatment and resuscitation skills, training in the promotion of asphyxiation and resuscitation of new methods, and transplanting the fetus in the abdomen without conditions are effective measures to reduce the mortality rate of birth asphyxia in newborns .