谢露　张铮　孙立平

[摘要] 目的 评估晚期早产的高危因素、晚期早产儿（LPIs）的复苏和低体温风险，并探讨LPIs过渡期并发症。 方法 采用回顾性队列研究的方法，选择首都医科大学大兴医院连续分娩的268例LPIs，按胎龄分成3组：34周组60例，35周组75例，36周组133例。统计分析孕母因素、分娩因素和新生儿因素的数据，观察两组产房复苏、新生儿出生时（T1）及生后2 h（T2）的体温。 结果 70例（26.1%）LPIs有孕母妊娠期并发症，34周组先兆子痫和肝内胆汁淤积症发生率显著高于35周组和36周组（均P < 0.05）；47例（17.5%）LPIs有通气复苏，36例（13.4%）需氧气复苏（面罩或气管插管），34周组通气复苏率显著高于35周组和36周组，差异均有统计学意义（P < 0.05）；不同胎龄及孕母产前类固醇治疗、自发性早产、剖宫产及先兆子痫情况患儿通气复苏率比较，差异有统计学意义（P < 0.05）；胎龄是LPIs氧气复苏的独立危险因素（P < 0.05）；从T1到T2，34周组正常体温的新生儿比率显著低于35周组和36周组，34周组LPIs的呼吸系统疾病发生率和新生儿重症监护室（NICU）入院率顯著高于35周组和36周组，差异均有统计学意义（P < 0.05）。 结论 LPIs的胎龄越小，尤其34周组胎龄儿，孕母妊娠期并发症越多，产房复苏和低体温的风险越大，呼吸系统疾病发生率和NICU入院率越高，过渡到子宫外环境的难度就越大，需要在出生时予以充分的靶向管理。

[关键词] 晚期早产儿；过渡；新生儿窒息复苏；体温调节；妊娠期并发症

[中图分类号] R722 [文献标识码] A [文章编号] 1673-7210（2018）07（b）-0074-05

Research of the transition from intra to extra-uterine environment of late preterm infant

XIE Lu ZHANG Zheng SUN Liping LIU Yuming DI Jianhui

Department of Pediatrics， Daxing Hospital Affiliated to Capital Medical University， Beijing 102600， China

[Abstract] Objective To evaluate the risk factors of late preterm infants （LPIs）， recovery and hypothermia of LPIs， and to explore the complications of transition of LPIs. Methods The retrospective cohort study was conducted on 268 LPIs delivered consecutively in Daxing Hospital Affiliated to Capital Medical University， and they were divided into three groups：60 cases of 34 weeks group， 75 cases of 35 weeks group and 133 cases of 36 weeks group， stratified by gestational age （GA）. Maternal and neonatal data， recovery， temperature at birth（T1） and 2 hours after birth （T2） were analyzed among all groups. Results Seventy cases （26.1%） of LPIs were diagnosed pregnancy complications during pregnancy， and preeclampsia and intrahepatic cholestasis were significantly higher in the 34 weeks group than in the 35 weeks and 36 weeks groups （all P < 0.05）. 47 cases （17.5%） of LPIs were diagnosed ventilation resuscitation， 36 cases （13.4%） needed oxygen resuscitation （mask or tracheal intubation）， the ratio of oxygen resuscitation in 34 weeks group was significantly higher than that of the 35 weeks group and 36 weeks group， and the differences were statistically significant （P < 0.05）. The differences in LPIs with different gestational age， and situation of prenatal steroid therapy， spontaneous preterm birth， cesarean section and preeclampsia of pregnant mother were statistically significant （P < 0.05）. Fetal age was an independent risk factor for oxygen recovery of LPIs （P < 0.05）. From T1 to T2， the ratio of normal body temperature of newborns in the 34 weeks group was significantly lower than that of the 35 weeks group and 36 weeks group， and incidence of LPIs respiratory diseases and NICU admission rate of 34 weeks group were significantly higher than those of 35 weeks group and 36 weeks group， and the differences were statistically significant （P < 0.05）. Conclusion The lower the GA of LPIs is， especially at 34 gestational weeks， the more maternal complications， the greater the need for resuscitation in delivery room， the risk of hypothermia， the higher the rate of respiratory diseases and NICU admission and the greater the difficulty of the transition from intra to extra-uterine environment in late preterm infant are， and target management at birth is reeded.

[Key words] Late preterm infant； Transition； Neonatal asphyxia resuscitation； Thermoregulation； Gestational diseases

晚期早产儿（late preterm infants，LPIs）定义为胎龄在340/7～366/7周的新生儿[1-2]，尽管被视为“近足月儿”，但LPIs的发病率和死亡率显著高于足月儿[3]，特别是LPIs的低体温和呼吸系统疾病比足月儿更常见[4]。由于LPIs的生理和代谢不成熟，缺乏自我调节能力，很难适应从子宫内到子宫外环境的过渡。从胎儿到新生儿过渡的特点是在呼吸功能、血液动力学和体温调节上的重要生理变化[5]，LPIs经历着延迟地或不充分地从子宫内过渡到子宫外环境的变化[6]，并被认为有较高的呼吸窘迫风险[7]。本研究旨在评估晚期早产的高危因素、LPIs的产房复苏和低体温风险，并探讨LPIs的过渡期并发症。

1 资料与方法

1.1 一般资料

选取2016年1月～2016年12月首都医科大学大兴医院（以下简称“我院”）连续分娩的268例LPIs为研究对象，按胎龄分成3组：34周组包括胎龄为340/7～346/7周的新生儿，35周组包括胎龄为350/7～356/7周的新生儿，36周组包括胎龄为360/7～366/7周的新生儿，进行回顾性队列研究，排除妊娠并发死产。……