早产儿脑白质损伤的危险因素分析  

Analysis of the risk factors of white matter damage in preterm infants

作　　者：赵航 冀湧 徐树明 赵建宇 Hang Zhao;Yong Ji;Shuming Xu;Jianyu Zhao(Department of Pediatrics,Shanxi Medical University,Taiyuan 030000,China;NICU,Shanxi Children's Hospital Affiliated to Shanxi Medical University,Taiyuan 030000,China)

机构地区：[1]山西医科大学儿科医学系,太原030000 [2]山西医科大学附属山西省儿童医院NICU,太原030000

出　　处：《国际儿科学杂志》2024年第4期277-282,共6页International Journal of Pediatrics

摘　　要：目的以脑室内出血(intraventricular hemorrhage,IVH)为重点研究早产儿脑白质损伤(white matter damage,WMD)的危险因素。方法回顾性分析2022年6月至2023年6月山西省儿童医院新生儿重症监护病房收治的639例早产儿的临床资料,根据头颅MRI结果将患儿分为WMD组(145例)和对照组(494例),采用单因素分析和多因素Logistic回归分析探讨早产儿发生WMD的危险因素。结果两组之间性别、胎龄、宫内窘迫、剖宫产、生后窒息、1 min Apgar评分、脐动脉pH值、母亲年龄、怀孕次数、试管婴儿、妊娠期高血压、妊娠期糖尿病、胎膜早破、急性绒毛膜羊膜炎比较差异无统计学意义(均P>0.05)。WMD组与对照组比较,出生体重[(1571±611)g比(1438±489)g,t=-2.393]、脐动脉碱剩余[-5.9(-8.2,-3.9)mmol/L比-5.3(-7.2,-3.5)mmol/L,Z=-2.538]、脐动脉乳酸[3.7(2.4,5.3)mmol/L比2.8(2.0,4.1)mmol/L,Z=-4.607]、败血症(28.5%比15.6%,χ^(2)=12.280)、动脉导管未闭(82.6%比74.7%,χ^(2)=3.911)、低碳酸血症(57.2%比45.0%,χ^(2)=6.696)、有创通气(75.9%比53.0%,χ^(2)=24.010)、多胎妊娠(19.3%比30.6%,χ^(2)=7.111)、产前使用糖皮质激素(51.0%比61.9%,χ^(2)=5.451)、最低PaCO_(2)[(28.4±6.7)mmHg比(31.4±8.0)mmHg,t=4.471]的差异均有统计学意义(均P<0.05)。两组间IVH的分布差异有统计学意义(χ^(2)=40.015,P<0.01),多重比较显示WMD组Ⅲ-Ⅳ级IVH的占比高于对照组(P<0.05)。多因素分析显示脐动脉乳酸、Ⅲ-Ⅳ级IVH、败血症和有创通气是早产儿发生WMD的主要危险因素,其OR值(95%CI)分别为1.121(1.023,1.228),11.435(3.925,33.314),1.758(1.064,2.904),1.640(1.004,2.680)。而多胎妊娠是早产儿发生WMD的保护因素,OR值(95%CI)为0.587(0.358,0.962)。结论脐动脉乳酸、Ⅲ-Ⅳ级IVH、败血症和有创通气是早产儿发生WMD的独立危险因素。Objective To investigate the risk factors of white matter damage(WMD)in premature infants,especially intraventricular hemorrhage(IVH).Methods This retrospective study included 639 premature infants admitted to the neonatal intensive care unit of Shanxi Children's Hospital from June 2022 to June 2023.The premature infants were divided into WMD group(145 cases)and control group(494 cases)according to the results of head MRI.Univariate analysis and multivariate logistic regression analysis were used to explore the risk factors for WMD in premature infants.Results There were no significant differences in gender,gestational age,fetal distress,cesarean section,asphyxia,Apgar 1min,umbilical artery pH,maternal age,number of pregnancy,infants of assisted reproductive technology,gestational hypertension,gestational diabetes mellitus,acute chorioamnionitis and prelabor rupture of membranes between the two groups(all P>0.05).Compared the WMD group with the control group,birth weight[(1571±611)g vs(1438±489)g,t=-2.393],umbilical artery base excess[-5.9(-8.2,-3.9)mmol/L vs-5.3(-7.2,-3.5)mmol/L,Z=-2.538],umbilical artery lactate[3.7(2.4,5.3)mmol/L vs 2.8(2.0,4.1)mmol/L,Z=-4.607],sepsis(28.5%vs 15.6%,χ^(2)=12.280),patent ductus arteriosus(82.6%vs 74.7%,χ^(2)=3.911),hypocarbia(57.2%vs 45.0%,χ^(2)=6.696),invasive ventilation(75.9%vs 53.0%,χ^(2)=24.010),multifetal pregnancy(19.3%vs 30.6%,χ^(2)=7.111),antenatal corticosteroids(51.0%vs 61.9%,χ^(2)=5.451),lowest PaCO_(2)value[(28.4±6.7)mmHg vs(31.4±8.0)mmHg,t=4.471]were different significantly(all P<0.05).There was significant difference in the distribution of IVH between the two groups(χ^(2)=40.015,P<0.01)and multiple comparisons showed that the proportion of gradeⅢ-ⅣIVH in the WMD group was higher than that in the control group(P<0.05).Multiple logistic regression analysis showed that umbilical artery lactate,gradeⅢ-ⅣIVH,sepsis and invasive ventilation were high risk factors of WMD,and multifetal pregnancy was protective factor of WMD,with OR(95%CI)1.121(1.023,1.2

关 键 词：婴儿 早产 脑白质损伤 危险因素 

分 类 号：R722.6[医药卫生—儿科]