2019 年第 3 期 第 14 卷

早产儿围产期高氨血症临床危险因素分析

Clinical risk factors of perinatal hyperammonemia in preterm infants

作者：彭湘莲房巧燕李婷胡伟

英文作者：

单位：410008长沙，湖南省妇幼保健院新生儿一科

英文单位：

关键词：早产儿；高氨血症；危险因素

英文关键词：

• 摘要：

• 【摘要】目的    研究早产儿围产期高氨血症的临床危险因素。方法    选择2016年5月至2017年5月湖南省妇幼保健院收治的71例高氨血症早产儿纳入观察组，同时选择75例血氨正常的早产儿作为对照组。比较2组早产儿基本临床资料，包括性别、胎龄、体质量、血常规、凝血功能、头颅超声检查结果等。观察2组早产儿的不良症状，包括喂养困难、呕吐、意识障碍、四肢肌张力减低、呼吸急促等。比较观察组不同预后早产儿血氨水平。采用多因素Logistic回归分析早产儿发生高氨血症的危险因素。结果    2组早产儿性别、胎龄、体质量比较，差异均无统计学意义(均P＞0.05)；观察组代谢性酸中毒、电解质紊乱、凝血功能障碍和头颅超声异常比例均明显高于对照组［40.8%(29/71)比21.3%(16/75)、45.1%(32/71)比17.3%(13/75)、32.4%(23/71)比17.3%(13/75)、43.7%(31/71)比14.7%(11/75)］，差异均有统计学意义(均P＜0.05)。2组喂养困难、呕吐比例比较差异均无统计学意义(均P＞0.05)；观察组意识障碍、四肢肌张力减低、呼吸急促比例均明显高于对照组，差异均有统计学意义(均P＜0.05)。观察组早产儿有52例预后良好，19例预后不良。预后良好和预后不良早产儿出生后24 h血氨水平比较差异无统计学意义(P＞0.05)；预后不良早产儿出生后48、72、96 h血氨水平均明显高于预后良好早产儿，差异均有统计学意义（均P＜0.05）。多因素Logistic回归分析结果显示，胎膜早破、出生后体内感染和剖宫产是早产儿发生高氨血症的独立危险因素(比值比=0.612、1.486、1.324，95%置信区间：0.278～0.831、1.143～1.867、1.127～1.684，均P＜0.05)。结论    胎膜早破、出生后体内感染和剖宫产是早产儿发生高血氨症的危险因素，需要有效监测血氨水平，血氨水平与早产儿预后相关，需采取有效措施减轻高氨血症对早产儿的危害。

• 【Abstract】Objective    To analyze the risk factors of hyperammonemia in preterm infants. Methods    From May 2016 to May 2017, 71 premature infants with hyperammonemia and 75 premature infants with normal blood ammonia were enrolled in Hunan Provincial Maternal and Child Health Care Hospital. Basic clinical data including gender, gestational age, weight, blood routine, coagulation function and cranial ultrasonographic findings were recorded. Clinical symptoms including feeding intolerance, vomiting, conscious disturbance, limb dystonia and shortness of breath were observed. Level of blood ammonia was analyzed among infants with different prognosis in observation group. Risk factors of hyperammonemia were analyzed by multivariate logistic regression. Results    There was no significant difference of gender, gestational age and body mass between groups(all P＞0.05). Rates of metabolic acidosis, electrolyte disturbance, coagulation dysfunction and abnormality of cranial ultrasound in observation group were significantly higher than those in control group［40.8%(29/71) vs 21.3%(16/75), 45.1%(32/71) vs 17.3%(13/75), 32.4%(23/71) vs 17.3%(13/75), 43.7%(31/71) vs 14.7%(11/75)］(all P＜0.05). There was no significant difference of feeding intolerance and vomiting between groups(both P＞0.05). Rates of consciousness disorder, limb dystonia and shortness of breath in observation group were significantly higher than those in control group (all P＜0.05). In observation group, 52 cases had good prognosis and 19 cases had poor prognosis; there was no significant difference of blood ammonia level at 24 h after birth between them(P＞0.05); blood ammonia levels at 48, 72 and 96 h after birth in infants with poor prognosis were significantly higher than those in infants with good prognosis(P＜0.05). Multivariate logistic regression showed that premature rupture of membranes, postnatal infection and cesarean section were independent risk factors of hyperammonemia(odds ratio＝0.612, 1.486, 1.324; 95% confidence interval: 0.278-0.831, 1.143-1.867, 1.127-1.684, all P＜0.05). Conclusion    Blood ammonia level is associated with the prognosis of preterm infants, especially in the cases with premature rupture of membranes, postnatal infection and cesarean section.