新生儿非心脏手术后转入新生儿重症监护病房的围手术期相关因素

doi:10.20274/j.cnki.issn.1674-3865.2026.05.007

摘要/Abstract

摘要：

目的探讨术前未接受高级生命支持的新生儿非心脏手术后转入新生儿重症监护病房（NICU）的相关因素。方法回顾性纳入2024年4月至2026年3月湖南省儿童医院接受气管插管全身麻醉非心脏手术的新生儿450例，按术后去向分为NICU组41例和非NICU组409例，比较两组围手术期资料，并进行多因素二元Logistic回归分析。结果转入NICU的发生率为9.1%（41/450）。多因素二元Logistic回归分析显示，术时矫正胎龄与术后转入NICU呈负相关（每增加1周，OR=0.697）；美国麻醉医师协会（ASA）身体状况分级、术中低氧血症及麻醉时间与术后转入NICU呈正相关，其中ASA分级每升高1级、发生术中低氧血症及麻醉时间每增加10 min的OR分别为3.700、2.946和1.164（均P<0.05）。结论术后NICU去向与术前成熟度、总体病情及术中氧合和麻醉经过相关，术毕可结合术前与术中信息重新评估监护级别和转运路径。

关键词: 新生儿, 新生儿重症监护病房, 非心脏手术, 术时矫正胎龄, 低氧血症

Abstract:

Objective To identify factors associated with postoperative neonatal intensive care unit(NICU) admission in neonates without preoperative advanced life support. Methods We retrospectively included 450 neonates who underwent noncardiac surgery under general anesthesia with tracheal intubation at Hunan Children's Hospital from April 2024 to March 2026 and divided them into two groups based on where they were sent after surgery. Perioperative data were compared between the NICU group(n=41) and the non-NICU group (n=409). Multivariable binary Logistic regression analysis was performed. Results NICU admission occurred in 9.1%(41/450). Multivariable binary Logistic regression analysis showed that adjusted gestational age at surgery was negatively associated with NICU admission(OR=0.697 per week increased),whereas American Society of Anesthesiologists(ASA) physical status, intraoperative hypoxemia, and anesthesia duration were positively associated with NICU admission(OR=3.700 per grade increased for ASA grading, OR=2.946 per 10 min increased in intraoperative hypoxemia, and OR=1.164 per 10 min increased in anesthesia duration, respectively; all P<0.05). Conclusion Postoperative NICU admission is associated with preoperative maturity, overall disease condition, intraoperative oxygenation, and anesthesia duration. After surgery, the monitoring grade and transfer pathway may be reassessed based on the data before and during surgery.

Key words: Neonate, Neonatal intensive care unit, Noncardiac surgery, Adjusted gestational age at surgery, Hypoxemia

中图分类号:

R722.1

杨潇潇, 危思维, 吴磊, 杜真. 新生儿非心脏手术后转入新生儿重症监护病房的围手术期相关因素[J]. 中国中西医结合儿科学, 2026, 18(5): 408-412.

Xiaoxiao YANG, Siwei WEI, Lei WU, Zhen DU. Perioperative factors associated with NICU admission after noncardiac surgery in neonates[J]. Chinese Pediatrics of Integrated Traditional and Western Medicine, 2026, 18(5): 408-412.

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变量	总体（n=450）	非NICU组（n=409）	NICU组（n=41）	U/χ²/t值	P值
术时日龄[M（P₂₅,P₇₅）,d]	5（2，12）	5（2，13）	3（2，7）	6 160.000	0.005
出生胎龄[M（P₂₅,P₇₅），周]	38.43（37.14，39.43）	38.43（37.29，39.43）	37.14（33.86，38.14）	5 111.000	<0.001
术时矫正胎龄[M（P₂₅,P₇₅），周]	39.29（38.00，40.71）	39.43（38.14，40.86）	37.43（34.14，38.57）	4 230.500	<0.001
早产儿[n（%）]	93（20.7）	74（18.1）	19（46.3）	18.137	<0.001
出生体质量[M（P₂₅,P₇₅）,kg]	3.10（2.70，3.40）	3.10（2.75，3.42）	2.60（1.89，3.05）	4 255.000	<0.001
术前体质量（x±s，kg）	3.04±0.64	3.10±0.60	2.42±0.71	5.839	<0.001
术前体质量<2.5 kg[n（%）]	75（16.7）	55（13.4）	20（48.8）	33.496	<0.001
男性[n（%）]	306（68.0）	282（68.9）	24（58.5）	1.857	0.173
ASA分级[n（%）]				28.464	<0.001
Ⅰ级	0（0.0）	0（0.0）	0（0.0）
Ⅱ级	72（16.0）	70（17.1）	2（4.9）
Ⅲ级	355（78.9）	327（80.0）	28（68.3）
Ⅳ级	23（5.1）	12（2.9）	11（26.8）
术前呼吸系统异常[n（%）]	91（20.2）	67（16.4）	24（58.5）	41.047	<0.001
术前心脏畸形[n（%）]	224（49.8）	200（48.9）	24（58.5）	1.350	0.245
术前CRP升高[n（%）]	70（23.9）	58（22.4）	12（35.3）	2.751	0.097
术前血红蛋白[M（P₂₅,P₇₅）,g/L]	156（134，172）	156（134，172）	157（143，171）	8 218.000	0.834
白蛋白[M（P₂₅,P₇₅）,g/L]	36.00（33.60，37.90）	36.15（33.90，37.90）	33.40（30.40，34.60）	4 772.000	<0.001

变量	总体（n=450）	非NICU组（n=409）	NICU组（n=41）	U/χ² 值	P值
急诊手术[n（%）]	268（59.6）	233（57.0）	35（85.4）	12.476	<0.001
手术类型[n（%）]				-	<0.001
腹腔镜	131（29.1）	128（31.3）	3（7.3）
胸腔镜	32（7.1）	21（5.1）	11（26.8）
开放/其他	287（63.8）	260（63.6）	27（65.9）
手术分级[n（%）]				11.764	0.003
Ⅰ级	0（0.0）	0（0.0）	0（0.0）
Ⅱ级	3（0.7）	3（0.7）	0（0.0）
Ⅲ级	324（72.0）	304（74.3）	20（48.8）
Ⅳ级	123（27.3）	102（24.9）	21（51.2）
麻醉时间[M（P₂₅,P₇₅）,min]	121（72.75，155）	115（66，152）	163（130，210）	3 923.500	<0.001
术中最高气道压[M（P₂₅,P₇₅）,cmH?O]	18（16，21）	18（16，20）	21（18，25）	5 672.500	0.001
呼气末二氧化碳分压[M（P₂₅,P₇₅）,mmHg]	42（37，47）	42（37，47）	42（35，49）	8 232.000	0.888
术中低体温[n（%）]	249（55.3）	222（54.3）	27（65.9）	2.020	0.155
术中低血压[n（%）]	204（45.3）	183（44.7）	21（51.2）	0.631	0.427
术中低氧血症[n（%）]	56（12.4）	41（10.0）	15（36.6）	24.128	<0.001
术中输血[n（%）]	24（5.3）	18（4.4）	6（14.6）	-	0.015
术中血管活性药物使用[n（%）]	39（8.7）	26（6.4）	13（31.7）	-	<0.001

因素	B	SE	Wald χ2值	校正OR（95%CI）	P值
术时矫正胎龄（每增加1周）	-0.360	0.084	18.480	0.697（0.592～0.822）	<0.001
ASA分级（每升高1级）	1.308	0.506	6.686	3.700（1.373～9.976）	0.010
术前呼吸系统异常（是与否）	0.717	0.416	2.970	2.048（0.906～4.628）	0.085
术中低氧血症（是与否）	1.080	0.472	5.249	2.946（1.169～7.423）	0.022
麻醉时间（每增加10 min）	0.152	0.037	16.989	1.164（1.083～1.251）	<0.001