性别对极低和超低出生体重儿脑室内出血的影响  

Effects of gender on incidence of intraventricular hemorrhage in very low and extremely low birth weight infants

作　　者：陈思[1] 林素[1] 张豪[1] 揭青青 尚鲲 王丽[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

出　　处：《中华围产医学杂志》2014年第5期317-322,共6页Chinese Journal of Perinatal Medicine

摘　　要：目的 探讨性别与极低出生体重儿（very low birth weight infant,VLBWI）和超低出生体重儿（extremely low birth weight infant,ELBWI）脑室内出血（intraventricular hemorrhage,IVH）的关系. 方法 纳入1999年1月1日至2012年1 2月31日入住温州医科大学附属第二医院新生儿重症监护病房出生体重＜1 500 g,人院日龄＜14 d的VLBWI和ELBWI1 008例.比较男性与女性VLBWI和ELBWI发生IVH和重度IVH的差异,分析IVH和重度IVH的高危因素.采用x2检验、t检验和非条件Logistic回归模型进行统计学分析. 结果 1 008例VLBWI和ELBWI中男性61 5例,女性393例;VLBWI 895例,ELBWI 113例.IVH发生率为15.1％（152/1 008）,重度IVH发生率为8.4％（85/1 008）.男性IVH发生率较女性升高[（1 7.2％（106/615）与11.7％（46/393）,x2=5.728,P＜0.05],重度IVH发生率也较女性升高[9.8％（60/615）与6.4％（25/393）,x3=3.896,P＜0.05].在出生体重1 250～1 499 g VLBWI中,男性IVH发生率高于女性[13.7％（47/344）与7.8％（17/217）,x2=4.473,P=0.034],重度IVH发生率也高于女性[7.6％（26/344）与2.8％ （6/217）,x2=5.684,P=0.017].Logistic回归分析显示,胎龄＜28周（aOR=2.012,95％CI：1.288～3.143,P＜0.05）、新生儿呼吸窘迫综合征（aOR=l.584,95％CI：1.007～2.492,P＜0.05）、有创机械通气（aOR=2.743,95％CI：1.826～4.121,P＜0.05）、电解质紊乱（aOR=2.128,95％CI：1.092～4.149,P＜0.05）和脑室周围白质软化（aOR=2.901,95％CI：1.312～6.416,P＜0.05）是IVH的独立危险因素,而男性不是IVH的独立危险因素（aOR=l.351,95％CI：0.917～1.991,P=0.128）.重度IVH的独立危险因素是胎龄＜28周（aOR=2.200,95％CI：1.305～3.708,P＜0.05）、有创机械通气（aOR=4.714,95％CI：2.809～7.911,P＜0.05）和电解质紊乱（aOR=2.232,95％CI：1.047～4.759,P＜0.05）,而男性不是重度IVH的独立危险因素（aOR=l.361,95％CI：0.823～2.252,P=0.247）. 结论 男性VLBWI和ELBWI发生IVH或重度IVH的风险高于女Objective To examine the relationship between gender and intraventricular hemorrhage （IVH） in very low birth weight infants （VLBWI） and extremely low birth weight infants （ELBWI）.Methods From January 1,1999 to December 31,2012,data on VLBWI and ELBWI,who were admitted to the neonatal intensive care unit of Yuying Children＇s Hospital within 14 d after birth,were retrospectively collected.The Chi-square test and t test were used to compare neonatal outcomes between male and female infants.The Logistic model was used to analyze the risk factors for IVH.Results A total of 1 008 cases were enrolled,including 615 males and 393 females,895 VLBWI and 113 ELBWI.The incidence of IVH was 15.1％ （152/1 008） and the incidence of severe IVH was 8.4％ （85/1 008）.Compared with females,males had a higher total incidence of IVH [17.2％ （106/615） vs 11.7％ （46/393）,x2=5.728,P＜0.05] and severe IVH [9.8％ （60/615） vs 6.4％ （25/393）,x2=3.896,P＜0.05].These differences were also seen in VLBWI with a birth weight of 1 250 to 1 499 g [IVH：13.7％ （47/344） vs 7.8％ （17/217）,x2=4.473,P=0.034; severe IVH：7.6％ （26/344） vs 2.8％ （6/217）,x2=5.684,P=0.017].Logistic regression analysis showed that the risk factors for IVH were as follows：gestational age ＜28 weeks （aOR=2.012,95％CI：1.288-3.143,P＜0.05）,neonatal respiratory distress syndrome （aOR=l.584,95％CI：1.007-2.492,P＜0.05）,invasive mechanical ventilation （aOR=2.743,95％CI：1.826-4.121,P＜0.05）,electrolyte disturbance （aOR=2.128,95％CI：1.092-4.149,P＜0.05） and periventricular leukomalacia （aOR=2.901,95％CI：1.312-6.416,P＜0.05）,but not male sex （aOR=1.351,95％CI：0.917-1.991,P=0.128）.The risk factors for severe IVH were gestational age ＜28 weeks （aOR=2.200,95％CI：1.305-3.708,P＜0.05）,invasive mechanical ventilation （aOR=4.714,95％CI：2.809-7.911,P＜0.05） and electrolyte disturbance （aOR=2.232,95％CI：1.047 4.759,P＜0.05）,but not male sex （aOR=1.361,

关 键 词：脑出血 脑室 婴儿 极低出生体重 婴儿 超低出生体重 性别因素 

分 类 号：R742[医药卫生—神经病学与精神病学]