辅助生殖技术超早产儿临床特征分析

doi:10.12372/jcp.2024.23e0954

摘要/Abstract

摘要：

目的分析辅助生殖技术（ART）超早产儿临床特征。方法收集新生儿重症监护室2016年1月至2022年12月收治的超早产儿临床资料，分为ART组、自然受孕(NC)组，比较两组间临床特征。结果研究期间共收治478例超早产儿，NC组279例，ART组199例。ART组与NC组比较发现：男性比例、母孕期胎膜早破>18 h发生率低于NC组，双/多胎发生率、母亲羊水异常和妊娠期糖尿病发生率、脑室周围-脑室内出血(PIVH)发生率、放弃+死亡率均高于NC组，以上差异均有统计学意义(P<0.05)。结论 ART超早产儿临床中PIVH发生较高，易导致放弃乃至引起死亡，需加强ART受孕者的母孕期保健，减少并发症发生，预防超早产。

关键词: 辅助生殖技术, 临床特征, 超早产儿

Abstract:

Objective To analyze the clinical characteristics of extremely premature infants conceived by assisted reproductive technology (ART). Methods The clinical data of extremely premature infants admitted to the neonatal intensive care unit from January 2016 to December 2022 were collected. The patients were divided into the ART group and the natural conception (NC) group, and the clinical features between the two groups were compared. Results A total of 478 extremely premature infants were admitted during the study period, including 279 in the NC group and 199 in the ART group. Compared with the NC group, the ART group had lower proportions of male infants and premature rupture of membranes lasting more than 18 hours, but higher proportions of double/multiple births, maternal amniotic fluid abnormalities, gestational diabetes mellitus, periventricular-intraventricular hemorrhage (PIVH), abandonment and death, and the differences were statistically significant (P<0.05). Conclusions The incidence of PIVH in extremely premature infants conceived by ART is higher, and their parents are easy to give up treatment, and the case fatality rate of patients is higher. It is necessary to strengthen the maternal health care during the ART pregnancy and reduce the complications, in order to prevent the occurrence of extremely premature births.

Key words: assisted reproductive technology, clinical characteristics, extremely premature infant

王越佳, 夏磊, 程慧清, 吕荣吉, 范锟, 徐发林. 辅助生殖技术超早产儿临床特征分析[J]. 临床儿科杂志, 2024, 42(7): 600-605.

WANG Yuejia, XIA Lei, CHENG Huiqing, LYU Rongji, FAN Kun, XU Falin. Clinical characteristics of extremely premature infants conceived by assisted reproductive technology[J]. Journal of Clinical Pediatrics, 2024, 42(7): 600-605.

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胎龄	总例数	ART[n(%)]
<24周	6	2（33.33）
24⁺周	23	11（47.83）
25⁺周	66	27（40.91）
26⁺周	140	65（46.43）
27⁺周	243	94（38.68）
合计	478	199（41.63）

年份	早产儿例数	超早产儿[n(%)]
2016	1 828	32（1.75）
2017	1 790	79（4.41）
2018	1 672	57（3.41）
2019	1 745	43（2.46）
2020	1 483	54（5.08）
2021	1 471	98（6.66）
2022	1 405	115（8.19）
合计	11 394	478（4.20）

项目	ART组(n=199）	NC组（n=279）	统计量	P
男性[n(%)]	108（54.27）	182（65.23）	χ²=5.85	0.016
出生体重($\bar{x}±s$)/g	918.09±169.38	933.67±156.21	t=1.04	0.300
胎龄($\bar{x}±s$)/周	26.96±0.73	27.04±0.68	t=0.80	0.428
身长($\bar{x}±s$)/cm	34.98±2.92	35.20±2.75	t=0.84	0.402
剖宫产[n(%)]	68(34.17)	86(30.82)	χ²=0.60	0.440
母亲年龄($\bar{x}±s$)/岁	30.67±4.53	31.51±4.95	t=1.89	0.060
双/多胎[n(%)]	94(47.24)	92(32.97)	χ²=9.94	0.002
孕次[M(P₂₅~P₇₅)]	2(1~3）	2(1~2)	Z=1.73	0.084
产次[M(P₂₅~P₇₅)]	2(1~2)	2(1~2)	Z=1.60	0.110
Apgar 1 min评分[n(%)]
≤3分	34(17.09)	39(13.98)	χ²=0.87	0.352
≤7分	153(76.88)	199(71.33)	χ²=1.85	0.174
Apgar 5 min评分[n(%)]
≤3分	8(4.02)	11(3.94)	χ²=0.00	0.966
≤7分	103(51.76)	154(55.20)	χ²=0.55	0.457
糖皮质激素[n(%)]
产前使用	161(80.90)	221(79.21)	χ²=0.21	0.649
满1个疗程	75(37.69)	113(40.50)	χ²=0.39	0.535

项目	ART组（n=199）	NC组（n=279）	χ²值	P
胎膜早破>18 h	34(17.09)	75(26.88)	6.33	0.012
羊水异常^1）	98(49.25)	112(40.14)	3.91	0.048
胎盘早剥	33(16.58)	49(17.56)	0.08	0.779
宫颈机能不全	54(27.14)	78(27.96)	0.04	0.843
甲状腺功能减低	15(7.54)	29(10.39)	1.13	0.287
妊娠期高血压	24(12.06)	45(16.13)	1.56	0.212
妊娠期糖尿病	38(19.10)	34(12.19)	4.33	0.037

项目	ART（n=199）	NC（n=279）	统计量	P
新生儿早发型败血症[n(%)]	33(18.44)	44(15.77)	χ²=0.06	0.812
新生儿晚发型败血症[n(%)]	21(20.59)¹⁾	38(17.67)²⁾	χ²=0.39	0.533
气管插管[n(%)]	150(75.38)	206(73.84)	χ²=0.06	0.803
PDA[n(%)]	119(59.80)	173(62.01)	χ²=0.24	0.625
肺出血[n(%)]	27(13.57)	29(10.39)	χ²=1.13	0.288
感染性肺炎[n(%)]	62(31.16)	116(41.58)	χ²=5.40	0.020
PVL[n(%)]	8(4.02)	10(3.58)	χ²=0.06	0.805
化脓性脑膜炎[n(%)]	5(2.51)	7(2.51)	χ²=0.00	0.998
甲状腺功能低下[n(%)]	11(9.17)³⁾	19(8.19)⁴⁾	χ²=3.34	0.068
中-重度BPD[n(%)]	43(56.58)⁵⁾	118(58.42)⁶⁾	χ²=0.08	0.782
ROP[n(%)]	28(35.53)⁵⁾	66(32.67)⁶⁾	χ²=0.20	0.653
新生儿胆汁淤积症[n(%)]	18(9.05)	30(10.75）	χ²=0.38	0.540
氧疗情况
有创机械通气时间($\bar{x}±s$)/d	8.97±1.27	8.12±0.85	t=0.52	0.602
无创机械通气时间($\bar{x}±s$)/d	34.36±1.71	31.02±1.17	t=1.45	0.125
氧疗总时间($\bar{x}±s$)/d	58.13±2.56	54.90±1.17	t=1.30	0.196
出院时纠正胎龄($\bar{x}±s$)/周	37.18±2.44	36.78±2.06	t=1.35	0.178
住院总时长($\bar{x}±s$)/d	59.39±3.06	54.66±1.71	t=1.38	0.169