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目的探讨影响1 min Apgar评分0~1分新生儿复苏结局的围产期因素、复苏过程及5 min Apgar评分对神经系统预后的影响。方法回顾性分析2010—2013年4年间在本院分娩的1 min Apgar评分0~1分的重度窒息患儿围产期因素和复苏后的临床资料。结果研究期间共有38例1 min Apgar评分0~1分患儿,1例放弃抢救,6例死亡,31例复苏成功患儿(81.6%)转入NICU进一步治疗,其中2例住院48 h内放弃治疗。1 min Apgar评分0~1分的围产期因素主要有胎盘早剥(9例)、早产(7例),先天畸形(4例)、羊水Ⅲ度污染(4例)、脐带异常(4例)和分娩困难(4例)等。31例成功复苏的0~1分重度窒息患儿中,5 min Apgar评分≤5分者(15例)脐动脉血气pH<7.0、早期有神经系统症状、头颅磁共振改变的比例均高于5 min评分>5分者(16例),差异有统计学意义(P<0.05),两组脑瘫发生率差异无统计学意义(P=0.072)。结论积极有效的复苏可使绝大多数1 min Apgar评分0~1分新生儿抢救成功,5 min Apgar评分≤5分患儿是重点关注人群。
Objective To investigate the influence of perinatal factors, the process of resuscitation and Apgar score at 5 minutes on the prognosis of the nervous system in neonates with 0 to 1 Apgar score. Methods The perinatal factors and post-recovery clinical data of children with severe asphyxia 1-minute Apgar score of 1 minute delivered in our hospital from 2010 to 2013 were retrospectively analyzed. Results A total of 38 children with a 1-minute Apgar score of 0 to 1 were recruited during the study period. One patient gave up resuscitation, six died, and 31 children succeeded in resuscitation (81.6%) were transferred to NICU for further treatment. Two of them were abandoned within 48 h of hospitalization treatment. 1 minute Apgar score of 0 to 1 perinatal factors mainly placental abruption (9 cases), premature birth (7 cases), congenital malformations (4 cases), amniotic fluid Ⅲ degree of contamination (4 cases), umbilical cord abnormalities (4 cases ) And childbirth difficulties (4 cases). Of the 31 children with severe asphyxia who were successfully resuscitated from 0 to 1, 5 cases of Apgar score ≤5 (n = 5) had umbilical arterial blood gas pH <7.0, early neurological symptoms and head magnetic resonance were all higher than 5 min score> 5 points (16 cases), the difference was statistically significant (P <0.05). There was no significant difference in the incidence of cerebral palsy between the two groups (P = 0.072). Conclusion Active and effective resuscitation can save the majority of newborns with Apgar scores of 0 to 1 at 1 min and rescue children with Apgar scores of 5 or less at 5 min.