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目的:了解我院近二十年来超低出生体重儿(extremely low birth weight infants,ELBWI)的临床特点,分析预后不良的危险因素,随访评估长期预后。方法:回顾我院1994年7月至2013年4月收治的117例体质量≤1 000 g的新生儿,其中符合诊断且资料全面的87例ELBWI临床资料,对预后好组与预后差组的围产期因素、临床干预策略及住院期间并发症进行比较,分析影响ELBWI近期预后的因素;并电话随访目前患儿的生存状况,返院完成体格测量及智力测评,了解远期生长发育情况。结果:87例ELBWI中21.84%存活;6.90%院内死亡,71.26%放弃治疗。预后好组平均胎龄大(t=2.400,P=0.016),试管婴儿(χ2=5.018,P=0.025)、产前使用糖皮质激素(χ2=8.809,P=0.012)、母亲患妊娠期高血压综合征比例高(χ2=7.513,P=0.031),肠内营养(χ2=15.046,P=0.000)、输注血液制品,白蛋白(χ2=4.629,P=0.006)、红细胞(χ2=19.97,P=0.000)及丙种球蛋白(χ2=4.660,P=0.031)比率高。预后差组呼吸机辅助通气比率高(χ2=15.155,P=0.000)。2组并发症不同。预后好组电话随访11/19例,返院随访6/11例。目前年龄最大者11岁4个月,年龄最小者1岁3个月。1例出现体格生长落后,2例出现发育落后。结论:随着ELBWI生存率提高,生长发育需要长期关注。
OBJECTIVE: To understand the clinical features of ELBWI in our hospital over the past two decades, analyze the risk factors of poor prognosis and evaluate the long-term prognosis. Methods: A total of 117 newborns with body mass ≤1 000 g admitted to our hospital from July 1994 to April 2013 were retrospectively reviewed. Among the 87 patients with ELBWI who were diagnosed with complete data, the data of 87 patients with good prognosis and poor prognosis Perinatal factors, clinical intervention strategies and complications during hospitalization, analysis of the factors that affect the short-term prognosis of ELBWI; and telephone follow-up of the current living conditions of children, back to the hospital to complete physical measurements and intelligence assessment to understand the long-term growth and development. Results: 87.8% of ELBWI survived, 6.90% died in hospital and 71.26% gave up treatment. The average gestational age was significantly higher in the good prognosis group (t = 2.400, P = 0.016), IVF = 5.018 (P = 0.025), glucocorticoid prenatal use (χ2 = 8.809, P = 0.012) (Χ2 = 7.529, P = 0.031), enteral nutrition (χ2 = 15.046, P = 0.000), blood products, albumin (χ2 = 4.629, P = 0.006), erythrocytes , P = 0.000) and gamma globulin (χ2 = 4.660, P = 0.031). Poor prognosis ventilator-assisted ventilation rate (χ2 = 15.155, P = 0.000). 2 groups of complications. Good prognosis group telephone follow-up 11/19 cases, 6/11 cases were followed-up. Currently the oldest 11 months and 4 months, the youngest 1 year and 3 months. One patient had poor physical growth and two patients had poor development. CONCLUSIONS: As ELBWI survival rates increase, growth and development require long-term concerns.