摘要
目的探讨针对我国国情和医疗管理体制现状下建立围产高危儿系统管理的临床价值。方法回顾性调查自逐步建立围产高危儿系统管理模式以来（1995～2008年），在广州市妇女儿童医疗中心分娩的新生儿的相关资料，分析反应高危儿管理后生活质量的主要指标，如围产期死亡率、窒息发生率、极低出生体重儿和超低出生体重儿存活率、发生中枢协调障碍的围产因素、干预效果及对气质影响因素、脐血血清免疫球蛋白E对过敏高危儿的预警情况等。结果1999～2008年分娩数及高危妊娠数逐年增加，但围产儿死亡率、窒息率呈明显下降趋势，极低和超低出生体重儿存活率不断提高；发生中枢协调障碍的各种高危因素，依次为胎儿宫内窘迫（30．5％）、母亲早期感染史（28．5％）、母亲患妊娠糖尿病者（27．8％）、足月小样儿（26．7％）、早产儿（25．8％）、新生儿窒息（25．0％）、新生儿缺血缺氧性脑病（23．1％）、妊娠早期阴道流血史（20．5％）、新生儿高胆红素血症（15．9％）等；系统管理高危儿较门诊对照组中中枢协调障碍患儿发现早、疗程短、疗效好。且气质研究对高危儿系统管理作用重大；脐血血清免疫球蛋白E对过敏高危儿确有预警作用。结论围产高危儿系统管理模式的建立，能有效提高国产儿生活质量。
Objective To evaluate clinical value of establishment of systematic management of high-risk perinatal infants according to China＇ s national conditions and status quo of medical management system. Methods The related clinical data of neonates born in Medical Center for Women and Children, The Affiliated Hospital of Guangzhou Medical College were retrospectively analyzed since establishment of systematic management model of perinatal high-risk infants （1995 - 2008 ）. The key indexes of quality of life after management of response high-risk infants, such as perinatal mortality rate, incidence of asphyxia, survival rates of very low birth weight infants and extremely low birth weight infant, perinatal factors of central coordination disorder, intervention effects and influencing factors of temperament, early warning of cord serum IgE for allergic high-risk infants were investigated. Results In the period from 1995 to 2008, although numbers of delivery and high-risk pregnancy were increased year by year, the perinatal mortality rate and neonatal asphyxia rate showed significantly declining trend, the survival rates of very low birth weight infants and extremely low birth weight infants were continuously improved. The risk factors of central coordination disorder included fetal distress （30.5%） , infection history of mother in early pregnancy （28.5%） , gestational diabetes mellitus （ GDM ） of mother （ 27. 8% ）, small for date infant （ 26. 7% ）, premature infant （ 25.8% ） , neonatal asphyxia （25.0%）, neonatal hypoxic-ischemic encephalopathy （ HIE ） （ 23. 1% ） , history of vaginal bleeding during early pregnancy （20.5%） , hyperbilirubinemia（ 15.9% ） and so on. Those infants with central coordination disorder among systematically managed high- risk infants were identified earlier, their course of treatment was shorter and the therapeutic effect was better than those out-patients in the control group. Temperament study of high-risk infants played important roles in systematic management. The cord serum level of IgE had early-warning for those allergic infants. Conclusion Establishment of systematic management model of perinatal high-risk infants can effectively improve quality of life of the perinatal infants.
出处
《中国妇幼健康研究》
2009年第6期613-615,618,共4页
Chinese Journal of Woman and Child Health Research
关键词
围产儿
高危儿
系统管理模式
生活质量
perinatal infant
high-risk infant
systematic management model
quality of life
