中国七大城市早产儿脑损伤发生率的多中心调查报告(英文)  

Incidences of brain injuries in premature infants in seven large cities of China

作　　者：陈惠金[1] 魏克伦[2] 周丛乐[3] 姚裕家[4] 杨于嘉[5] 范秀芳[6] 高喜容[7] 刘晓红[8] 钱继红[9] 吴本清 张青梅[11] 张小兰[12] 吴高强 

机构地区：[1]上海市儿科医学研究所,上海200092 [2]中国医科大学附属二院 [3]北京大学附属第一医院,北京100034 [4]四川大学附属华西第二医院 [5]中南大学附属湘雅医院 [6]山东省济南市妇幼保健院 [7]湖南省儿童医院 [8]深圳市儿童医院 [9]上海交通大学医学院附属新华医院,上海200092 [10]深圳市人民医院 [11]沈阳市妇婴医院 [12]深圳市妇幼保健院 [13]新疆乌鲁木齐市妇幼保健院

出　　处：《临床儿科杂志》2011年第11期1001-1011,共11页Journal of Clinical Pediatrics

基　　金：The project is sponsored by the Subspecialty Group of Neonatology of Pediatric Society, China Medical Association.

摘　　要：目的中华医学会儿科学分会新生儿学组组织国内7个城市的10家三级甲等医院进行了早产儿脑损伤多中心协作研究。该文报告其中早产儿脑损伤发生率的调查结果。方法 2005年1月至2006年8月期间,各参加单位对所有胎龄<37周的早产儿在生后3 d内常规进行初次床边头颅B超检查,以后每隔3～7 d复查1次,直至出院。结果 9单位总脑室内出血(IVH)发生率和重度IVH发生率分别为10.8%(406/3 768)和2.4%(92/3 768),其中I级IVH 22.6%(92/406),Ⅱ级54.7%(222/406),Ⅲ级17.2%(70/406),Ⅳ级5.4%(22/406);10医院中总脑室周围白质软化(PVL)发生率和囊性PVL发生率分别为2.3%(112/4 933)和0.3%(16/4 933),其中Ⅰ级PVL 85.7%(96/112),Ⅱ级12.5%(14/112),Ⅲ级1.8%(2/112)。发生重度IVH的可能高危因素为阴道分娩(OR=1.874,95%CI=1.172～2.997,P<0.01)、围产期窒息(OR=1.598,95%CI=1.077～2.372,P<0.05)、机械呼吸(OR=3.988,95%CI=2.448～6.948,P<0.01)以及羊水污染(OR=2.192,95%CI=1.054～4.544,P<0.05)等。发生囊性PVL的可能高危因素为阴道分娩(OR=1.400,95%CI=1.186～1.652,P<0.001)和机械呼吸(OR=3.000,95%CI=1.015～8.864,P<0.05)。结论该调查数据基本可以客观反映中国主要大城市早产儿脑损伤发生率的情况。由于中国60%以上的人口居住在农村,受农村医疗条件的限制,早产儿IVH发生率很有可能高于目前的调查结果,尚有待进一步组织包括乡村医院的多中心调查研究。Objectives To investigate the incidence of brain injuri in premature infants in ten hospitals of seven large cities in China sponsored by the Subspecialty Group of Neonatology of Pediatric Society,China Medical Association.Methods All premature infants with gestational age less than 37 weeks in ten hospitals were given routine cranial ultrasound within three days of birth,and then repeated every 3-7 days till the discharge from the hospital during January 2005 to August 2006.Results Incidence of intraventricular hemorrhage（IVH）and severe IVH were 10.8%（406/3 768）and 2.4%（92/3 768）with 22.6%（92/406）for grade 1,54.7%（222/406）for grade 2,17.2%（70/406）for grade 3 and 5.4%（22/406）for grade 4 in nine hospitals;incidence of periventricular leukomalacia（PVL）and cystic PVL were 2.3%（112/4 933）and 0.3%（16/4 933）with 85.7%（96/112）for grade 1,12.5%（14/112）for grade 2,and 1.8%（2/112）for grade 3 including all ten hospitals,respectively.Risk factors associated with increased severity of IVH were vaginal delivery（OR = 1.874,95% CI = 1.172-2.997,P〈0.01）,perinatal asphyxia（OR = 1.598,95% CI = 1.077-2.372,P〈0.05）,mechanical ventilation（OR = 3.988,95% CI = 2.448-6.948,P〈0.01）,and amniotic fluid contamination（OR = 2.192,95% CI = 1.054-4.544,P〈0.05）.Risk factors that might result in the development of cystic PVL were vaginal delivery（OR = 1.400,95% CI = 1.186-1.652,P 〈0.001）and mechanical ventilation（OR = 3.000,95% CI = 1.015-8.864,P〈0.05）.Conclusions These data reflect basically the prevalence of brain injuriy in premature infants in major cities of China.However,more than 60% of population lives in the rural area,further multicenter investigation including the rural area is expected to be undertaken in future.

关 键 词：早产儿 脑室内出血 脑室周围白质软化 发病率 多中心调查 中国 

分 类 号：R722.6[医药卫生—儿科]