Objective To study the clinical features and follow-up of newborns with severe hypoxic-ischemic encephalopathy ( HIE) , and to provide the basis for rational diagnosis, treatment and follow-up.Methods Clinical data of cases of HIE from the Neonatal Department of our Hospital from January 2011 to October 2014 were studied retrospectively. The data of general information, laboratory examination, treatment, outcome, follow-up and prognosis of the patients were collected. Multivariate logistic regression analysis was used to study the influential factors of the prognosis of HIE.Results A total of 123 infants with sever HIE were enrolled in our study. In addition to general therapy, 6 cases were treated with mild hypothermia, and 21 cases were treated with high pressure oxygen. 60 cases improved our treatment, 55 cases had withdrawal treatment with parental consent, and 8 cases died. Single factor analysis showed that 5 minutes Apgar score, convulsions, coma, pH, BE, organ injury, and mild hypothermia treatment were the risk factors that affect the prognosis of severe HIE. Multiple factors analysis showed that 5 min Apgar score <3 points ( OR=4. 071 ,95℅CI 1. 309-15. 613 ) and BE≤-10 mmol/L ( OR=36. 810, 95℅CI 5. 913-41. 119) were independent risk factors of prognosis of severe HIE ( P<0. 05). Hospitalization within the first 72 hours of life ( OR=0. 096, 95℅CI 0. 096-0. 353) was a protective factor of severe HIE. Multiorgan injury ( mainly the injury of brain, lung and heart) and electrolyte imbalance ( mainly hypocalcemia and hyponatremia ) were common complications of serve HIE. In the follow-up of these patients, 33 cases were loss in follow up, and 49 cases died (8 cases died during hospitalization, 41 cases died after withdrawal of treatment). The top five causes of death were abandonment of treatment due to financial reasons and the fear of adverse outcome (n=20), multiple organ dysfunction ( n =16 ) , and pneumothorax ( n =4 ) , diffuse intravascular coagulation (n=6), and shock (n=3). 41 cases survived were followed up for 9~54 months. The critical clinical conditions observed among these infants included cerebral palsy ( n = 5 ) , epilepsy ( n = 3 ) and developmental retardation(n=26).Conclusions There are many complications of severe HIE.The mortality of severe HIE is high, and the incidence of poor outcome of survivors is also high. Timely detection of risk factors is the key to the prevention of severe HIE. Long-term prognosis of severe HIE requires proper organization of neonatal follow up.%目的 分析新生儿重度缺氧缺血性脑病(HIE)的临床特点及随访情况,为合理诊治及随访提供依据.方法 选择2011年1月至2014年10月我院足月新生儿病房收治的重度HIE患儿临床资料进行回顾性分析,总结患儿一般资料、辅助检查、治疗、转归、随访和预后情况,对影响患儿预后的因素进行多元Logistic回归分析.结果 共纳入123例重度HIE患儿,除常规治疗外,6例予亚低温治疗,21例予高压氧治疗,治疗好转60例,放弃治疗55例,住院死亡8例.单因素分析显示5 min Apgar评分、惊厥、昏迷、pH、BE、脏器损伤、亚低温治疗是影响重度HIE患儿预后的危险因素;多因素分析显示5 min Apgar评分<3分(OR=4.071,95℅CI 1.309~15.613)、BE≤-10 mmol/L(OR=36.810,95℅CI 5.913~41.119)是影响重度HIE患儿预后的独立危险因素(P<0.05),入院日龄<72 h(OR=0.096,95℅CI 0.026~0.353)是影响重度HIE患儿预后的保护性因素.重度HIE患儿易合并脏器损伤和电解质紊乱,其中脏器损伤以脑、肺、心损伤最常见,电解质紊乱以低钙、低钠多见.123例患儿中,33例失访,49例死亡(8例住院期间死亡,41例放弃治疗后死亡),死亡原因前五位分别为因经济因素及担心后遗症放弃治疗(20例)、多脏器功能损伤(16例)、气胸(4例)、弥散性血管内凝血(6例)、休克(3例).41例存活患儿进行9~54个月随访,5例继发脑瘫,3例继发癫疒间;7例发育大致正常;其余26例发育落后于同龄患儿.结论 重度HIE患儿病死率高,合并症多,留有后遗症比率高.及时发现危险因素是预防重度HIE的关键,对重度HIE更远期预后的随访工作需积极开展.
展开▼
