早产儿脑损伤的高危因素  

High Risk Factors of Brain Injury in Preterm Infants

作　　者：陆亚东[1] 刘登礼 贲晓明[1] 

机构地区：[1]南京医科大学附属南京儿童医院新生儿医疗中心,南京210008 [2]汕头市妇女儿童医院新生儿科,广东汕头515041

出　　处：《实用儿科临床杂志》2008年第24期1882-1884,共3页Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金项目资助(30471836)

摘　　要：目的探讨引起早产儿脑损伤的高危因素,以降低其发病率,改善神经发育预后。方法对2005年8月-2007年8月本院NICU收治的130例早产儿于出生第1、3、4、7、15天及第1、3、6个月行颅脑超声检查,Ⅰ、Ⅱ级脑室内出血(IVH)为轻度脑损伤;Ⅲ、Ⅳ级IVH/脑室周围白质软化(PVL)为重度脑损伤。应用SPSS11.5统计软件对其胎龄、出生体质量、母亲有无妊娠高血压综合征、胎膜早破、分娩方式(阴道分娩、剖宫产)、患儿产前有无宫内窘迫、产时有无窒息、窒息复苏(包括气管插管或面罩加压给氧)、是否给予肺泡表面活性物质、出生后有无呼吸暂停、惊厥、低氧血症、高碳酸血症、低碳酸血症、酸中毒、有无吸氧、是否采用鼻塞持续呼吸道正压(nCPAP)或呼吸机辅助通气17个项目行Logistic回归分析。结果130例早产儿中,颅脑超声检出脑损伤88例,发生率66.7%。其中,轻度脑损伤29例(占33%)(IVHⅠ级5例,Ⅱ级24例);重度脑损伤59例(占67%)[IVHⅢ级53例,Ⅳ级1例,PVL5例(伴IVHⅠ级1例,Ⅱ级、Ⅲ级各2例)]。胎龄越小、出生体质量越低,脑损伤发生率越高;窒息复苏、出生后低氧血症及采用nCPAP或呼吸机辅助通气也是早产儿脑损伤较重要的高危因素,这些因素均可影响早产儿脑血流自主调节功能,触发或加重脑损伤。结论小胎龄、低出生体质量、窒息复苏、低氧血症及辅助通气等为早产儿脑损伤高危因素,通过影响早产儿脑血流自主调节功能,进而影响脑血流动力学参数,导致早产儿脑损伤的发生。Objective To explore the high risk factors of brain injury in preterm infants, and to reduce its morbidity and improve the developmental outcome. Methods One hundred and thirty preterm infants, who were admitted to our neonatal intensive care unit（NICU） between Aug. 2005 and Aug. 2007, were scanned by echo in 1,3,4,7,15 days,and 1,3 and 6 months after birth, respectively. Those who had intraventricular hemorrhage（IVH） of grade Ⅰ or Ⅱwere regarded as mild brain injury, whereas those who had IVH of grade Ⅲ or Ⅳ or periventricular leukomalacia （PVL） were regarded as severe brain injury. Logistic regression was adopted to analyze 17 factors： gestational age, birth weight, hypertension syndrome during pregnancy, premature rupture of membranes, modalities of delivery, fetal distress, asphyxiate, resuscitation, surfactant, apnea, seizures, hypoxia, hypercarbia, hypocarbia, acidosis, use of oxygen, nasal constant positive airway pressure or mechanical ventilation. Results Among 130 preterm infants,88 cases（66.7% ） were detected with brain injury, which included 29 cases（33% ） with mild brain injury （5 cases with IVH of grade Ⅰ ,24 cases with IVH of grade Ⅱ） and 59 cases （67%） with severe brain injury（53 cases with IVH of grade Ⅲ,Ⅰ case with IVH of grade Ⅳ and 5 cases with PVL）. Gestational age and birth weight were the fundamental factors of brain injury in premature infants. The smaller the gestational age and the lower the birth weight,the highter the brain injury rate. Resuscitation, hypoxia, the use of auxiliary ventilation were also important high risk factors of brain injury in preterm infants. All these high risk factors could influence the autoregulation of cerebral blood and trigger or aggravate brain injury of preterm infants. Conclusions Smaller gestational age, lower birth weight, resuscitation, hypoxia, the use of auxiliary ventilation were all the high risk factors of brain injury in premature infants, which could influence the parameters of cerebral bloo

关 键 词：婴儿 新生 脑损伤 高危因素 胎龄 出生体质量 窒息复苏 脑血流 

分 类 号：R722.6[医药卫生—儿科] R748[医药卫生—临床医学]