目的 总结四川大学华西第二医院病房全程管理的内外科嵌合模式下新生儿外科术后不良事件的发生情况,并分析影响术后不良事件的危险因素.方法 纳入2019年1月至2021年12月在四川大学华西第二医院接受外科手术的272例新生儿.记录术后综合不良事件的发生情况,并根据并发症发生情况将患儿分为有症状组和无症状组.通过单因素与多因素分析影响新生儿外科手术后不良事件的高危因素.结果 术后共有108例新生儿发生综合不良事件.单因素分析结果显示,有症状组与无症状组男性患儿占比,胎龄,出生体质量,产后1 min Apgar评分,术前诊断为坏死性小肠炎或/和消化道穿孔、早产儿、低出生体质量儿患儿占比,入手术室时机控呼吸患儿占比、平均动脉压(MAP),急诊手术患儿占比,术中输注红细胞悬液比较,差异均有统计学意义(P<0.05).多因素Logistic回归分析结果表明:胎龄过小(OR=0.972,95%CI=0.950～0.994,P=0.014)与入手术室时的MAP过低(OR=0.955,95%CI:0.919～0.993,P=0.019)是影响新生儿术后不良事件发生的独立危险因素.结论 病房全程管理的内外科嵌合模式下胎龄过小与入手术室MAP过低是影响新生儿术后不良事件发生的独立危险因素,提高产前诊断措施,优化胎儿子宫内及子宫外生长时间以降低胎龄带来的相关影响,提高新生儿入手术室时血压或许能降低新生儿术后不良事件的发生率,改善长期预后.
Risk factors analysis of postoperative adverse events in newborns under the integrated management of internal and external departments in the ward
Objective To summarize the occurrence of postoperative adverse events in neonatal surgery under the integrated manage-ment of internal and external departments in the ward of West China Second University Hospital,Sichuan University,and analyze the risk factors affecting postoperative adverse events.Methods A total of 272 newborns who underwent surgical procedures in West China Second University Hospital,Sichuan University from January 2019 to December 2021 were included.The occurrence of postoperative comprehen-sive adverse events was recorded,and the newborns were divided into the symptomatic group and the asymptomatic group according to the occurrence of complications.The high-risk factors that affecting postoperative adverse events in neonatally surgical procedures were analyzed by univariate analysis and multivariate analysis.Results There were 108 newborns experienced comprehensive adverse events after surgery.The results of univariate analysis showed that there were statistically significant differences in the proportion of male newborns,gestational age,birth weight,Apgar score 1 minute postpartum,the proportion of newborns with preoperative diagnosis of necrotizing small enteritis or/and gastrointestinal perforation,premature infants and low birth weight infants,the proportion of newborns with respiratory control when admitted to the operating room and mean arterial pressure(MAP),the proportion of newborns underdoing emergency surgery,and intraoperative infusion of red blood cell suspension between the two groups(P<0.05).The results of multivariate Logistic regression analysis showed that the small gestational age(OR=0.972,95%CI=0.950～0.994,P=0.014)and low MAP when admitted to the operating room(OR=0.955,95%CI:0.919～0.993,P=0.019)were the independent risk factors affecting the occurrence of postoperative adverse events in newborns.Conclusion Under the integrated management of internal and external departments in the ward,the small gestational age and low MAP when admitted to the operating room are the independent risk factors for the occurrence of postoperative adverse events in newborns.Improving the prenatal diagnostic measures and optimizing the time of fetal growth in and out of utero to reduce the associated effects of gestational age,and increasing the neonatal blood pressure when admitted to the operating room may reduce the incidence of postoperative adverse events in newborns and improve long-term prognosis.
万方数据
维普
