窒息新生儿糖代谢紊乱对近期预后的影响：一项湖北省多中心研究

Effect of glucose metabolism disorders on the short-term prognosis in neonates with asphyxia: a multicenter study in Hubei Province,China

摘要:

目的 分析窒息新生儿糖代谢紊乱对近期预后的影响。 方法 回顾性纳入湖北省52家医院2018年1~12月收治的生后12 h内有血糖数据的窒息患儿，收集病历资料及生后1、2、6、12 h的血糖数据，允许时间误差为0.5 h。根据住院期间是否诊断脑损伤和/或死亡分为预后不良组（693例）及预后良好组（779例）。分析两组患儿生后12 h内糖代谢紊乱情况及其对近期预后的影响。 结果 预后不良组中来自二级医院（48.5% vs 42.6%）、重度窒息（19.8% vs 8.1%）、亚低温治疗（4.8% vs 1.5%）的比例及糖代谢紊乱发生率（18.8% vs 12.5%）均高于预后良好组（P<0.05）；预后不良组生后1、2、6 h糖代谢紊乱发生率均高于预后良好组（P<0.05）。多因素logistic回归分析显示，反复高血糖为窒息患儿预后不良的独立危险因素（校正后OR=2.380，95%CI：1.275~4.442，P<0.05）。 结论 窒息患儿合并反复高血糖可能提示近期预后不良，应加强对该类患儿的早期神经系统监测与管理。

Abstract:

Objective To study the effect of glucose metabolism disorders on the short-term prognosis in neonates with asphyxia. Methods A retrospective analysis was performed on the medical data of the neonates with asphyxia who were admitted to 52 hospitals in Hubei Province of China from January to December, 2018 and had blood glucose data within 12 hours after birth. Their blood glucose data at 1, 2, 6, and 12 hours after birth (with an allowable time error of 0.5 hour) were recorded. According to the presence or absence of brain injury and/or death during hospitalization, the neonates were divided into a poor prognosis group with 693 neonates and a good prognosis group with 779 neonates. The two groups were compared in the incidence of glucose metabolism disorders within 12 hours after birth and short-term prognosis. Results Compared with the good prognosis group, the poor prognosis group had a significantly higher proportion of neonates from secondary hospitals (48.5% vs 42.6%, P<0.05) or with severe asphyxia (19.8% vs 8.1%, P<0.05) or hypothermia therapy (4.8% vs 1.5%, P<0.05), as well as a significantly higher incidence rate of disorder of glucose metabolism (18.8% vs 12.5%, P<0.05). Compared with the good prognosis group, the poor prognosis group had a significantly higher incidence rate of disorder of glucose metabolism at 1, 2, and 6 hours after birth (P<0.05). The multivariate logistic regression analysis showed that recurrent hyperglycemia (adjusted odds ratio=2.380, 95% confidence interval: 1.275-4.442, P<0.05) was an independent risk factor for poor prognosis in neonates with asphyxia. Conclusions Recurrent hyperglycemia in neonates with asphyxia may suggest poor short-term prognosis, and it is necessary to strengthen the early monitoring and management of the nervous system in such neonates.