摘要目的 分析羊水污染、宫内胎儿窘迫与新生儿缺血缺氧性脑病的关联性.方法 选取2015年8月至2017年4月广州市增城区妇幼保健院新生儿科收治的91例缺血缺氧性脑病患儿为病例组,男54例,女37例,胎龄(34. 89 ± 1. 64)周,胎龄范围为31~38周,出生1 h内发病.另选取同期129例健康新生儿为健康组,男76 例,女53 例,胎龄(35. 04 ± 1. 76)周,胎龄范围为32 ~39周.比较两组子痫前期、新生儿窒息、阴道顺产、剖宫产、阴道手术产、宫内胎儿窘迫、脐带异常、羊水过少、羊水污染、胎盘早剥发生率.采用logistic回归分析新生儿缺血缺氧性脑病危险因素,采用Spearman分析宫内胎儿窘迫、羊水污染与新生儿缺血缺氧性脑病的相关性.结果 病例组子痫前期[57. 1% (52/91)]、新生儿窒息[100% (91/91)]、阴道手术产[9. 9% (9/91)]、宫内胎儿窘迫[64. 8% (59/91)]、胎盘早剥[35. 2% (32/91)]、脐带异常[30. 8% ( 28/91 )]、羊水过少[14. 3% (13/91)]、羊水污染[ 50. 5% ( 46/91 )]发生率均高于健康组[ 6. 2% (8/129 )、20. 9% (27/129 )、0. 8% (1/129)、20. 9% (27/129)、5. 4% (7/129)、3. 1% (4/129)、1. 6% (2/129)、7. 0% (9/129)],差异有统计学意义(P<0. 05);经logistic回归分析可知,子痫前期、新生儿窒息、阴道手术产、宫内胎儿窘迫、脐带异常、羊水过少、羊水污染、胎盘早剥均为新生儿缺血缺氧性脑病发病危险因素(P<0. 05);经Spearman检验可知,宫内胎儿窘迫、羊水污染均与新生儿缺血缺氧性脑病呈正相关(P<0. 05).结论 宫内胎儿窘迫、羊水污染均为新生儿缺血缺氧性脑病发生独立危险因素,且与新生儿缺血缺氧性脑病呈正相关,临床中应极力消除或减少此类危险因素,进而有效预防新生儿缺血缺氧性脑病.

abstractsObjective To analyze the relationship among amniotic fluid contamination,intrauterine fetal distress and neonatal hypoxic-ischemic encephalopathy. Methods From August 2015 to April 2017, 91 children with ischemic hypoxic encephalopathy who were admitted were selected as the case group,54 males and 37 females,with gestational age(34. 89 ± 1. 64) weeks and gestational age ranging from 31 to 38 weeks. In addition,129 healthy newborns in the same period were selected as the healthy group,including 76 males and 53 females,with gestational age(35. 04 ± 1. 76) weeks and gestational age ranging from 32 to 39 weeks. The incidence of preeclampsia,neonatal asphyxia,vaginal vaginal delivery,cesarean section,vagi-nal operation,intrauterine fetal distress,umbilical cord abnormality,oligohydramnios,amniotic fluid pollu-tion and placental abruption were compared between the two groups. Logistic regression was used to analyze the risk factors of neonatal ischemic hypoxic encephalopathy,and Spearman was used to analyze the correla-tion between intrauterine fetal distress,amniotic fluid pollution and neonatal ischemic hypoxic encephalopa-thy. Results The incidence of preeclampsia[57. 1% (52/91)],neonatal asphyxia[100% (91/91)],vagi- nal surgery[9. 9% (9/91)], intrauterine fetal distress [ 64. 8% ( 59/91)], umbilical cord abnormalities [35. 2% (32/91)],oligohydramnios[30. 8% (28/91)],amniotic fluid contamination[14. 3% (13/91)] and placental abruption[50. 5% (46/91)] were higher than those in the control group[6. 2% (8/129), 20. 9% (27/129),0. 8% (1/129),20. 9% (27/129),5. 4% (7/129),3. 1% (4/129),1. 6% (2/129) and 7. 0% (9/129)],and the difference was statistically significant ( P <0. 05). Logistic regression analysis showed that preeclampsia,neonatal asphyxia,vaginal surgery,intrauterine fetal distress,umbilical cord ab-normalities,oligohydramnios,amniotic fluid contamination and placental abruption are neonatal hypoxic-is-chemic encephalopathy risk factors( P<0. 05 ). Spearman test showed that intrauterine fetal distress and amniotic fluid contamination were positively correlated with neonatal hypoxic-ischemic encephalopathy(P<0. 05). Conclusion Intrauterine fetal distress and amniotic fluid pollution are independent risk factors for neonatal hypoxic-ischemic encephalopathy and positively correlated with neonatal hypoxic-ischemic enceph-alopathy. Clinical efforts should be made to eliminate or reduce such risk factors,so as to effectively prevent neonatal hypoxic-ischemic encephalopathy.