早产儿严重脑室内出血继发脑积水危险因素分析  

Risk factors of hydrocephalus secondary to severe intraventricular hemorrhage in preterm infants

作　　者：陈冠初 高红霞[1] 杨婷[1] 谈笑[1] 易彬[1] 唐建明[1] Chen Guanchu;Gao Hongxia;Yang Ting;Tan Xiao;Yi Bin;Tang Jianming(Department of Neonatology,Gansu Provincial Women and Child-care Hospital,Gansu Provincial Pediatric Medical Center,Gansu Central Hospital,Lanzhou 730050,China)

机构地区：[1]甘肃省妇幼保健院,甘肃省中心医院,甘肃省儿童医学中心新生儿科,兰州730050

出　　处：《中华新生儿科杂志（中英文）》2023年第7期407-411,共5页Chinese Journal of Neonatology

基　　金：甘肃省自然科学基金(21JR11RA168);甘肃省儿科临床医学研究中心(18JR2FA004);甘肃省卫生行业科研项目(GSWSKY-2019-17)。

摘　　要：目的分析早产儿严重脑室内出血(intraventricular hemorrhage,IVH)继发脑积水的危险因素,以预防、早期识别出血后脑积水(post-hemorrhagic hydrocephalus,PHH)。方法选择2013年6月至2021年6月甘肃省妇幼保健院新生儿科收治的严重IVH(Ⅲ~Ⅳ级)早产儿进行回顾性研究,根据是否发生PHH分为PHH组和非PHH组,组间比较采用秩和检验或χ2检验,多因素分析采用二分类logistic回归模型(向前逐步回归法)。结果共纳入246例严重IVH早产儿,PHH组68例(27.6%),非PHH组178例(72.4%)。多因素分析显示男性(OR=2.014,95%CI 1.063~3.817)、胎龄≤30周(OR=2.240,95%CI 1.210~4.146)、5 min Apgar评分≤5分(OR=3.980,95%CI 1.483~10.685)、胎盘早剥(OR=2.940,95%CI 1.324~6.531)是早产儿发生PHH的独立危险因素,血小板减少是早产儿发生PHH的保护因素(OR=0.305,95%CI 0.147~0.632)。非PHH组中度血小板减少比例高于PHH组,差异有统计学意义(P<0.05);两组轻、重度血小板减少比例差异无统计学意义(P均>0.05)。结论男性、胎龄≤30周、5 min Apgar评分≤5分、胎盘早剥是严重IVH早产儿发生PHH的危险因素,中度血小板减少可能对其有保护作用。Objective To study the risk factors of secondary hydrocephalus after severe intraventricular hemorrhage(IVH)in preterm infants for prevention and early identification of post-hemorrhagic hydrocephalus(PHH).Methods From June 2013 to June 2021,preterm infants with severe IVH admitted to our hospital were retrospectively analyzed.They were assigned into PHH group and non-PHH group.Rank sum test or chi-square test was used for comparison between the two groups and multivariate logistic regression analysis was used to analyze the risk factors of PHH in preterm infants.Results A total of 246 preterm infants with severe IVH were enrolled,including 68 cases(27.6%)in the PHH group and 178 cases(72.4%)in the non-PHH group.Multivariate logistic stepwise regression analysis showed that male gender(OR=2.014,95%CI 1.063-3.817),gestational age≤30 week(OR=2.240,95%CI 1.210-4.146),5-min Apgar score≤5(OR=3.980,95%CI 1.483-10.685),placental abruption(OR=2.940,95%CI 1.324-6.531)were independent risk factors for PHH in preterm infants and thrombocytopenia was the protective factor for PHH in preterm infants(OR=0.305,95%CI 0.147-0.632).The incidence of moderate thrombocytopenia in non-PHH group was significantly higher than PHH group(P<0.05).No significant differences existed in the incidences of mild and severe thrombocytopenia between the two groups(P>0.05).Conclusions Male gender,gestational age≤30 week,5-min Apgar score≤5,placental abruption are risk factors for PHH in premature infants with severe IVH and moderate thrombocytopenia has protective effects.

关 键 词：脑室内出血 脑积水 早产儿 危险因素 

分 类 号：R722.6[医药卫生—儿科]