极/超早产儿重度脑室内出血危险因素及脑血流监测的病例对照研究  

Cerebral hemodynamic monitoring and risk factors of severe intraventricular hemorrhage in extremely and very preterm infants:a case control study

作　　者：晏路标[1] 陈玉林[1] 韩树萍[1] 余章斌[1] 张俊[1] Yan Lubiao;Chen Yulin;Han Shuping;Yu Zhangbin;Zhang Jun(Department of Neonatology,Maternity and Child Health Care Hospital of Nanjing,Nanjing 210004,China)

机构地区：[1]南京市妇幼保健院新生儿科,南京210004

出　　处：《中华新生儿科杂志（中英文）》2022年第4期315-320,共6页Chinese Journal of Neonatology

基　　金：江苏省妇幼健康科研项目(F201642);江苏省妇幼健康重点人才(FRC201740);南京市医学科技发展基金(ZKX16062)。

摘　　要：目的探讨极/超早产儿重度脑室内出血(intraventricular hemorrhage, IVH)的危险因素、脑血流动力学参数和转归。方法选择2019年1~12月南京市妇幼保健院新生儿科收治的胎龄<32周早产儿进行回顾性分析, 根据是否发生重度IVH分为重度IVH组和非重度IVH组, 分析重度IVH的危险因素;根据校正胎龄40周时转归情况将重度IVH组再分为好转组和未好转组(有并发症), 比较两组脑血流动力学参数。结果共纳入346例患儿, 重度IVH组 38例(11.0%), 其中Ⅲ级、Ⅳ级IVH发生率分别为8.7%(30/346)、2.3%(8/346);非重度IVH组308例(89.0%)。Logistic回归分析结果显示, 胎龄<28周(OR=4.365, 95%CI 1.055~18.054), 5 min Apgar评分≤7分(OR=8.749, 95%CI 2.214~36.042)、绒毛膜羊膜炎(OR=3.245, 95%CI 1.127~9.344)、1 h二氧化碳分压波动>25 mmHg(OR=7.728, 95%CI 1.738~80.907)、使用血管活性药物(OR=10.883, 95%CI 3.746~31.621)是发生重度IVH的危险因素。重度IVH患儿中死亡6例, 好转组20例, 未好转组12例, 好转组大脑中动脉血流阻力下降较快, 平均血流速率恢复较快。结论出生胎龄<28周、5 min Apgar评分≤7分、绒毛膜羊膜炎、1 h 二氧化碳分压波动>25 mmHg、使用血管活性药物是极/超早产儿发生重度IVH的危险因素, 动态脑血流监测对重度IVH并发症的发生有一定提示意义。Objective To study the risk factors,cerebral hemodynamics and clinical outcomes of extremely and very preterm infants with severe intraventricular hemorrhage(IVH).Methods From January 2019 to December 2019,premature infants with gestational age(GA)<32 w admitted to our hospital were assigned into severe IVH group and non-severe IVH group.Risk factors for severe IVH were analyzed.According to clinical outcomes,severe IVH group was further assigned into improvement subgroup and no-improvement subgroup.Cerebral hemodynamic parameters were compared between the two groups.Results A total of 346 eligible neonates were enrolled in this study.The incidence of severe IVH was 11.0%(38 cases).The incidences of GradeⅢandⅣIVH were 8.7%(30/346)and 2.3%(8/346),respectively.Multivariate logistic regression analysis showed that CA<28 w(OR=4.365,95%CI 1.055~18.054),5 min Apgar score≤7(OR=8.749,95%CI 2.214~36.042),chorioamnionitis(OR=3.245,95%CI 1.127~9.344),PaCO2 fluctuation within 1 h>25 mmHg(OR=7.728,95%CI 1.738~80.907)and vasoactive drugs usage(OR=10.883,95%CI 3.746~31.621)were the risk factors of severe IVH.20 cases in severe IVH group were improved at discharge and 12 cases showed no improvement at discharge.Improvement subgroup showed quicker reduction of the middle cerebral artery flow resistance and faster recovery of the mean flow velocity than the no-improvement subgroup.Conclusions GA<28 w,5 min Apgar score≤7,chorioamnionitis,PaCO2 fluctuation within 1 h>25 mmHg and vasoactive drugs usage are risk factors of severe IVH in extremely and very preterm infants.Cerebral hemodynamic monitoring may provide initial assessment for the clinical outcomes for severe IVH.

关 键 词：脑室内出血 重度 危险因素 脑血流动力学 极早产儿 超早产儿 

分 类 号：R722.6[医药卫生—儿科]