极低和超低出生体质量儿脑室内出血的高危因素分析  

Risk factors for intraventricular hemorrhage in very low and extremely low birth weight infants

作　　者：陈思[1] 林素[1] 吴百威 尚鲲 董亚[1] 林振浪[1] 

机构地区：[1]温州医科大学附属第二医院、育英儿童医院新生儿科,325027 [2]富阳市人民医院儿内科

出　　处：《中华实用儿科临床杂志》2014年第2期114-119,共6页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的 分析极低出生低质量儿（VLBWI）和超低出生体质量儿（ELBWI）脑室内出血（IVH）发生发展的高危因素.方法 回顾1999年1月1日至2011年12月31日入住温州医科大学附属第二医院所有VLBWI和ELBWI临床资料,按是否发病分为IVH组和非IVH组,前者包括轻度IVH和重度IVH,进而分析围生期各种因素在不同组内的差异.IVH的严重性采用Papile分度法,并应用SPSS 16.0统计学软件对数据进行处理和分析.结果 共收集病例925例,IVH发病率12.6％（117/925例）,重度IVH占58.4％（66/113例）.母亲妊娠高血压病、产龄≥30岁、胎龄、出生体质量、男性、小于胎龄早产儿、重度窒息、胎盘异常、肺炎、新生儿呼吸窘迫综合征、肺出血、有创机械通气、应用肺表面活性物质（PS）、慢性肺疾病、坏死性小肠结肠炎（NEC）在IVH组和非IVH组的分布差异均具有统计学意义（P均＜0.05）.经Logistic回归分析,IVH的独立危险因素为胎龄＜28周[校正后优势比（AOR）2.583;95％ CI：1.357 ～4.916,P=0.004]、产龄≥30岁（AOR1.638;95％ CI：1.061 ～2.530,P=0.026）、有创机械通气（AOR2.098;95％ CI：1.262 ～3.488,P=0.004）、NEC（AOR3.064;95％CI：1.391～ 6.750,P=0.005）、应用PS（AOR1.794;95％ CI：1.057 ～3.045,P=0.030）、肺出血（AOR3.372;95％CI：1.138 ～9.989,P=0.028）、蛛网膜下腔出血（SAH）（AOR4.936;95％ CI：1.717～14.184,P=0.003）、脑白质软化（PVL）（AOR3.157;95％ CI：1.294 ～7.701,P=0.012）、缺氧缺血性脑损伤（HIBD） （AOR3.777;95％CI：1.637 ～8.716,P=0.002）.有创机械通气是重度IVH的独立危险因素（AOR 4.333;95％ CI：1.861 ～10.088,P=0.001）.结论 各种母亲因素、胎儿因素及产后因素均能影响IVH的发生.IVH的独立危险因素为胎龄＜28周、产龄≥30岁、有创机械通气、NEC、应用PS、肺出血、SAH、PVL和HIBD.重度IVH的独立危险因素是有创机械通气.Objective To analyze the influencing factors for intraventricular hemorrhage in the very low birth weight infants （VLBWI） and extremely low birth weight infants（ELBWI）.Methods The clinical data of all VLBWI and ELBWI in the Second Hospital of Wenzhou Medical College from Jan.1,1999 to Dec.31,2011 were retrospectively collected.They were divided into the intraventricular hemorrhage （IVH） group and non-IVH group,which included mild and severe IVH in IVH group,and then the differences of perinatal factors were analyzed in the different groups.The severity of IVH was graded based on Papile classification,and SPSS 16.0 statistical software was used for the data processing and analysis.Results A total of 925 cases were collected,and the incidence rate of IVH was 12.6％ （117/925 cases）,in which the severe IVH accounted for 58.4％ （66/113 cases）.Factors like maternal hypertension,maternal age ≥ 30 years,gestational age,birth weight,male,small for gestational age,severe asphyxia,placental abnormalities （including placental abruption,placenta praevia,placenta adhesion,small placenta,aging of placenta）,pneumonia,neonatal respiratory distress syndrome,pulmonary hemorrhage,invasive mechanical ventilation,using pulmonary surfactant （PS）,chronic lung disease （CLD）,necrotizing enterocolitis （NEC） were significantly different between 2 study groups （all P ＜ 0.05）.Logistic regression analysis identified that gestational age ＜ 28 weeks （AOR 2.583 ; 95 ％ CI：1.357-4.916,P =0.004）,maternal age ≥ 30 years （A OR 1.638 ; 95 ％ CI：1.061-2.530,P =0.026）,invasive mechanical ventilation （AOR 2.098 ;95 ％ CI：1.262-3.488,P =0.004）,NEC （A OR 3.064 ;95 ％ CI：1.391-6.750,P =0.005）,using PS（AOR 1.794;95％ CI：1.057-3.045,P =0.030）,pulmonary hemorrhage（AOR 3.372;95％ CI：1.138-9.989,P =0.028）,subarachnoid hemorrhage （SAH） （AOR 4.936 ;95 ％ CI：1.717-14.184,P =0.003）,periventricular leukomalacia（PVL） （AOR 3.157 ;95％ CI：1.294-7.701,P =0.012�

关 键 词：婴儿 极低出生体质量 婴儿 超低出生体质量 脑室内出血 高危因素 

分 类 号：R722.151[医药卫生—儿科]