早产儿脑损伤的影响因素研究  

Influencing Factors of Brain Injury in Premature Infants

作　　者：方小红[1] 许丽萍[1] 林丽聪[1] 陈雯雯[1] 张浩[1] 黄小玲[1] 

机构地区：[1]福建医科大学附属漳州市医院儿科,福建省漳州市363000

出　　处：《中国全科医学》2017年第4期459-464,共6页Chinese General Practice

基　　金：福建省卫生厅青年科研课题立项(2012-3-113)

摘　　要：目的探讨早产儿脑损伤(BIPI)的影响因素。方法选取2014年6月—2015年12月在福建医科大学附属漳州市医院出生且立即入住新生儿监护病房(NICU)的早产儿151例。采用颅脑B超和MRI检查诊断早产儿的BIPI(包括出血性脑损伤、缺血性脑损伤)发生情况,通过查阅病历的方法收集早产儿的临床资料,采用多因素Logistic回归分析探讨早产儿发生出血性脑损伤、缺血性脑损伤的影响因素。结果 151例早产儿中,共发生BIPI 61例(40.4%),其中出血性脑损伤47例(31.1%),缺血性脑损伤33例(21.8%),出血性合并缺血性脑损伤19例(12.6%)。不同胎龄,产妇是否发生绒毛膜羊膜炎(HCA),新生儿期是否发生脓毒症、低氧窒息、代谢性酸中毒、进行机械通气早产儿的出血性脑损伤发生率比较,差异有统计学意义(P<0.05);不同性别、分娩方式、出生体质量及是否多胎,产妇是否发生妊娠期糖尿病(GDM)、妊娠期高血压、孕期感染、使用地塞米松,新生儿期是否发生低血糖、高碳酸血症、低碳酸血症、合并肺部并发症早产儿的出血性脑损伤发生率比较,差异无统计学意义(P>0.05)。产妇是否发生HCA,新生儿期是否发生脓毒症、低氧窒息、进行机械通气早产儿的缺血性脑损伤发生率比较,差异有统计学意义(P<0.05);不同性别、胎龄、分娩方式、出生体质量及是否多胎,产妇是否发生GDM、妊娠期高血压、孕期感染、使用地塞米松,新生儿期是否发生低血糖、代谢性酸中毒、高碳酸血症、低碳酸血症、合并肺部并发症早产儿的缺血性脑损伤发生率比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示:胎龄,产妇是否发生HCA,新生儿期是否发生脓毒症、低氧窒息、代谢性酸中毒是早产儿发生出血性脑损伤的影响因素(P<0.05);产妇是否发生HCA,新生儿期是否发生脓毒症、低氧窒息是早产儿发生缺血性脑损伤的影响因素(PObjective To analyze the influencing factors for brain injury in premature infants（BIPI）. Methods The subjects enrolled in this study were 151 premature infants who were born in Zhangzhou Affiliated Hospital of Fujian Medical University from June 2014 to December 2015 and admitted to the Neonatal Intensive Care Unit（NICU） immediately after birth. B-ultrasound and magnetic resonance imaging（MRI） were used to detect the incidence of BIPI,including hemorrhagic brain injury and ischemic brain injury. We collected the clinical data of the premature infants by consulting their medical records. The factors affecting the incidences of hemorrhagic brain injury and ischemic brain injury in premature infants were analyzed with a multivariate Logistic regression model. Results Of the 151 premature infants,61（40. 4%） had brain injuries,including 47（31. 1%） with hemorrhagic brain injury and 33（21. 8%） with ischemic brain injury,and 19（12. 6%） with hemorrhagic and ischemic brain injury. Results of single factor analysis showed that gestational age,puerperants with histological chorioamnionitis（HCA）,neonatal sepsis,hypoxia and asphyxia,metabolic acidosis,mechanical ventilation were significantly associated with hemorrhagic brain injury（P〈0. 05）. Neonatal sex, mode of delivery, birth weight, polyembryony, maternal gestational diabetes mellitus（GDM）,gestational hypertension,infection during pregnancy,maternal dexamethasone treatment,neonatal hypoglycemia,hypercapnia, hypocapnia, and pulmonary complications were not strongly correlated with hemorrhagic brain injury（P〈0. 05）. Puerperants with HCA,neonatal sepsis,hypoxic and asphyxia,mechanical ventilation were remarkably associated with ischemic brain injury（P〈0. 05）. Neonatal sex, gestational age, mode of delivery, birth weight,polyembryony,maternal GDM, gestational hypertension, infection during pregnancy, maternal dexamethasone treatment,neonatal hypoglycemia, metabolic acidosis, hypercapnia, hypocapnia, and pulmonary complica

关 键 词：婴儿 早产 脑损伤 影响因素分析 

分 类 号：R722[医药卫生—儿科] R651.15[医药卫生—临床医学]