目的 探讨早期新生儿凝血功能异常达危急值的危险因素及其与危重病例的相关性.方法 选取2019年5月至2021年9月濉溪县医院新生儿科收治的凝血功能异常达危急值的100例早期新生儿作为危急值组,并按1∶1比例随机选择同期住院凝血功能未达危急值的早期新生儿100例作为对照组.依据新生儿危重病例评分(neonatal critical illness scores,NCIS)评估病情危重程度,对其临床资料进行回顾性分析.对凝血功能异常达危急值的相关危险因素进行单因素和多因素Logistic回归分析.结果 危急值组发生危重病例的比例高于对照组[60.0%(60/100)与27.0%(27/100),χ2=22.154,P<0.001].早期新生儿凝血功能异常达危急值与危重病例相关(Pearson列联系数C=0.316,P<0.001).单因素分析结果显示,危急值组的胎儿窘迫、重度窒息、早期早产儿、中期早产儿、新生儿呼吸窘迫综合征、胎盘早剥、低体温、酸中毒的比例均高于对照组(P值均<0.05).多因素Logistic回归分析结果显示,胎儿窘迫(OR=8.528,95%CI:1.728~42.085,P=0.009)、重度窒息(OR=10.129,95%CI:2.109~48.685,P=0.004)、早期早产儿(OR=15.689,95%CI:3.385~72.722,P<0.001)、中期早产儿(OR=10.186,95%CI:3.579~28.988,P<0.001)是早期新生儿凝血功能异常达危急值的独立危险因素.结论 胎儿窘迫、重度窒息、早期早产儿、中期早产儿是早期新生儿凝血功能异常达危急值的独立危险因素.早期新生儿凝血功能异常达危急值与危重病例相关.
Objective To explore the risk factors of critical value of abnormal coagulation function in early neonates and its correlation with neonatal critical degree.Method A total of 100 early neonates with critical value of abnormal coagulation function hospitalized in the Department of Neonatology,the Hospital of Suixi County from May 2019 to September 2021 were selected as the critical value group,and 100 early neonates hospitalized with non-critical value of abnormal coagulation function during the same period were randomly selected as the control group according to a ratio of 1∶1.Neonatal critical illness scores(NCIS)were used to evaluate the severity of neonatal critical illness,and the clinical data were retrospectively analyzed.Univariate and multivariate Logistic regression were used to analyze the risk factors related to the critical value of abnormal coagulation function.Result The proportion of critical illness in the critical value group was higher than that in the control group[60.0%(60/100)and 27.0%(27/100),χ2=22.154,P<0.001].Early neonatal critical value of abnormal coagulation function were associated with critical illness(Pearson correlation number C=0.316,P<0.001).Univariate analysis showed that the proportions of fetal distress,severe asphyxia,early prematurity,middle prematurity,neonatal respiratory distress syndrome,placental abruption,hypothermia and acidosis in the critical value group were higher than those in the control group(all P<0.05).Multivariate Logistic regression analysis showed that fetal distress(OR=8.528,95%CI:1.728-42.085,P=0.009)and severe asphyxia(OR=10.129,95%CI:2.109-48.685,P=0.004),early prematurity(OR=15.689,95%CI:3.385-72.722,P<0.001),middle prematurity(OR=10.186,95%CI:3.579-28.988,P<0.001)were independent risk factors for critical value of abnormal coagulation function in early neonates.Conclusion Fetal distress,severe asphyxia,early and middle prematurity are the independent risk factors of critical value of abnormal coagulation function in early neonates.The critical values of abnormal coagulation function in early neonates are correlated with critical illness,and critical illness have a higher probability of latent critical value of abnormal coagulation function.