早产儿脑损伤的危险因素分析  

Risk factors for brain injury of premature infants

作　　者：刘艳会[1] 钟庆华[1] 沈俊 梁琨[1] Liu Yanhui;Zhong Qinghua;Shen Jun;Liang Kun(Department of Pediatrics,the First Affiliated Hospital of Kunming Medical University,Yunnan,Kunming 650032,China)

机构地区：[1]昆明医科大学第一附属医院儿科,云南昆明650032

出　　处：《发育医学电子杂志》2022年第2期114-119,共6页Journal of Developmental Medicine (Electronic Version)

基　　金：地区科学基金(2019-81960102)。

摘　　要：目的探讨早产儿脑损伤(脑室内出血和脑白质损伤)的危险因素。方法2014年6月1日至2019年5月31日,在昆明医科大学第一附属医院分娩的出生胎龄28~33+6周的早产儿473例中,入住新生儿科的活产儿443例,排除顽固性低血糖、胆红素脑病、放弃治疗及死亡病例,共纳入392例。结合围产期病史及新生儿早期临床表现,以头颅磁共振成像诊断为主要依据,诊断脑室内出血及脑白质损伤。将患儿分为脑室内出血组(102例)、轻度脑白质损伤组(32例)、中重度脑白质损伤组(31例)及无脑损伤组(227例)。统计学方法采用χ^(2)检验、t检验和Logistic回归模型,分析早产儿不同类型脑损伤的危险因素。结果392例胎龄28~33+6周的早产儿中,脑损伤发生率为42.1%(165/392),其中脑室内出血发生率为26.0%(102/392),脑白质损伤发生率为16.1%(63/392)。Logistic回归模型显示,脑室内出血的危险因素:重度妊娠期高血压疾病(OR=2.287,95%CI:1.099~4.758,P<0.05)、支气管肺发育不良(OR=2.670,95%CI:1.418~5.029,P<0.01)、晚发型败血症(OR=2.318,95%CI:1.234~4.357,P<0.01)、机械通气(OR=1.936,95%CI:1.067~3.517,P<0.05)。轻度脑白质损伤的危险因素:临床型绒毛膜羊膜炎(OR=9.864,95%CI:2.364~41.155,P<0.05)、新生儿窒息(OR=3.319,95%CI:1.394~7.906,P<0.05)、脐动脉血气pH<7.00(OR=4.953,95%CI:1.527~13.024,P<0.05)。中重度脑白质损伤的危险因素:重度妊娠期高血压疾病(OR=4.213,95%CI:1.473~12.052,P<0.05)、机械通气(OR=5.029,95%CI:1.914~13.193,P<0.05)。结论早产儿不同类型的脑损伤存在不同的危险因素。重度妊娠期高血压疾病及机械通气为脑室内出血及中重度脑白质损伤的共同高危因素,应引起高度重视。Objective To investigate the relationship of different types in brain injury(intraventricular hemorrhage and periventricular leukomalacia)associated with perinatal factors in preterm infants.Method From June 1st,2014 to May 31st,2019,among 473 premature infants with gestational age of 28-33+6 weeks delivered in the Obstetrics Department of the First Affiliated Hospital of Kunming Medical University,443 live births were admitted to the Neonatal Department.After excluding intractable hypoglycemia,bilirubin encephalopathy,abandonment of treatment and death cases,392 cases were included.Combined with perinatal history and early clinical manifestations of newborns,the diagnosis of intraventricular hemorrhage and periventricular leukomalacia was based on cranial magnetic resonance imaging.The cases were divided into intraventricular hemorrhage group(102 cases),mild periventricular leukomalacia group(32 cases),moderate and severe periventricular leukomalacia group(31 cases)and no brain injury group(227 cases).Statistical methods were used byχ^(2) test,t-test and Logistic regression model to analyze the correlation between different types of brain injury and perinatal factors in preterm infants.Result Among 392 preterm infants of gestational age from 28-33+6 weeks,the incidence of brain injury was 42.1%(165/392),including 26.0%(102/392)of ventricular hemorrhage and 16.1%(63/392)of periventricular leukomalacia.The Logistic regression model was performed.The risk factors for intraventricular hemorrhage were as follows:Severe hypertensive disorders in pregnancy(OR=2.287,95%CI:1.099-4.758,P<0.05),bronchopulmonary dysplasia(OR=2.670,95%CI:1.418-5.029,P<0.01),late-onset sepsis(OR=2.318,95%CI:1.234-4.357,P<0.01),mechanical ventilation(OR=1.936,95%CI:1.067-3.517,P<0.05).The risk factors of mild periventricular leukomalacia were clinical chorioamnionitis(OR=9.864,95%CI:2.364-41.155,P<0.05),neonatal asphyxia(OR=3.319,95%CI:1.394-7.906,P<0.05),pH value of umbilical arterial blood gas analysis<7.00(OR=4.953,95%CI:1.527-13.024,P<0.0

关 键 词：早产儿 脑白质损伤 脑室内出血 围产期因素 妊娠期高血压疾病 机械通气 

分 类 号：R722.6[医药卫生—儿科]