超低出生体重儿重度早产儿视网膜病26例临床特征及疗效分析  

Analysis of clinical characteristics and treatment outcomes for 26 cases of extremely low birth weight in- fants with severe retinopathy of prematurity

作　　者：连朝辉[1] 冯冉冉[1] 赵捷[1] 张国明[2] 唐松[2] 杨传忠[1] 

机构地区：[1]南方医科大学深圳妇幼保健院,深圳518028 [2]深圳市眼科医院,518026

出　　处：《中国小儿急救医学》2013年第5期491-493,共3页Chinese Pediatric Emergency Medicine

摘　　要：目的分析患有重度早产儿视网膜病（retinopathyofprematurity，ROP）的超低出生体重儿（extremelylowbirthweightinfants，ELBWI）的临床特征，并评价ELBWI的ROP筛查管理模式、眼底激光光凝术及联合玻璃体腔内注入血管内皮生长因子拮抗剂Avastin的临床效果及治疗时机。方法对2004年7月1日2011年6月30日间在我院新生儿重症监护室住院抢救存活的出生体重小于1000g的45例ELBWI，在生后4～6周，由眼底病专科医生定期用双目间接眼底镜进行ROP筛查，对发展成为重度ROP的患儿眼底进行激光光凝术治疗，部分急进性后部ROP（aggressiveposteriorROP，APROP）患儿预先行玻璃体腔内注入Avastin。结果45例ELBWI中，筛查过程中13例始终未出现ROP（28．89％），6例（13．33％）出现1—2期ROP并在随访期自然恢复；26例发展成重度ROP（57．78％），其中APROP3例（6．67％）。对重度ROP患儿给予激光光凝术治疗，3例APROP则在激光光凝术前联合玻璃体腔内注入Avastin。全部患儿均能保留视力，成功率达100％。结论ELBWI重度ROP的发病率高，预防重点是及时筛查并在阈值期间给予眼底激光光凝术治疗，APROP则在激光光凝术前玻璃体腔内注入Avastin。呼吸管理是术后处理的关键。Objective To analyze the clinical characteristics of severe retinopathy of prematurity （ROP） in extremely low birth weight infants （ELBWI）, and to evaluate the management model of ROP screening of ELBWI and the clinical effects and treatment timing of photocoagulation with intravitreous injec- tion of vascular endothelial growth factor inhibitor （Avastin）. Methods Forty-five cases of ELBWI （birth weight 〈 1000 g） survived finally in our neonatal intensive care unit from July 1,2004 to June 30,2011 were reviewed. ROP screening was regularly performed in 4 ~ 6 weeks postpartum with binocular indirect fundus- cope by ophthalmologists. Newborns with severe ROP were treated with laser photocoagulation in the fundus. Some newborns that developed aggressive posterior ROP（APROP） were treated with combined intravitreous injection of Avastin and photocoagulation. Results Thirteen of 45 cases （ 28. 89% ） had not developed to ROP finally. Six cases （ 13.33% ） developed to stage 1 - 2 ROP and then spontaneous recovery during the follow-up period. Twenty-six newborns （57. 78 % ） developed to severe aggressive posterior ROP （APROP） and need to be treated with photocoagulation. All 3 APROP infants （6. 67% ） were received intravitreous Avas- tin injection prior to photocoagulation. The visual acuity of all 45 patients （ 100% ） in this study was preserved. Conclusion ELBWI have a higher morbidity of severe ROP. Timely screening and intervention are effective to prevent disease progression. Intravitreous Avastin injection prior to photocoagulation may be necessary to preserve the visual acuity of infants with APROP. Respiratory management is the key for post-operation care.

关 键 词：视网膜病 超低出生体重儿 激光光凝术 

分 类 号：R722.6[医药卫生—儿科]