机构地区:[1]贵州医科大学附属医院新生儿科,贵州贵阳550004 [2]贵阳市第二人民医院新生儿科,贵州贵阳550081
出 处:《贵州医科大学学报》2025年第4期564-570,共7页Journal of Guizhou Medical University
基 金:贵州省科技计划项目(黔科合基础-ZK〔2022〕一般415);贵州医科大学附属医院院级研究项目(2021-GMHCT-001)。
摘 要:目的探讨新生儿重症监护室(neonatal intensive care unit,NICU)内早产儿颅内出血的发生及其严重程度的影响因素。方法150例NICU早产儿分脑室内出血(intraventricular hemorrhage,IVH)组(n=80)和无IVH(non-IVH)组(n=70),IVH组早产儿据IVH病情严重程度(Ⅰ、Ⅱ级为轻度,Ⅲ、Ⅳ级为严重)进一步分为轻度IVH组(n=65)和严重IVH组(n=15),收集所有早产儿及其母亲的临床资料,包括产前情况(母亲是否合并妊娠期高血压、使用硫酸镁、足疗程使用激素、胎盘早剥,胎儿是否宫内窘迫、宫内感染、脐带异常)、分娩方式、产后情况[出生窒息、出生胎龄(GA)、出生质量(BW)及性别]、合并症[头颅血肿、新生儿呼吸窘迫综合征(NRDS)、代谢性酸中毒、低血糖症、早发型败血症(EOS)、凝血功能异常及贫血]、治疗(机械通气模式、血管活性药物使用)以及住院期间头颅超声检查情况[有无IVH,IVH程度],采用logistic回归分析早产儿IVH发生及严重程度的影响因素。结果IVH组NICU早产儿GA、BW、剖宫产比例、产前激素、硫酸镁治疗比例低于non-IVH组(P<0.05),胎盘早剥比例、产时窒息、代谢性酸中毒、贫血、凝血功能异常、NRDS、EOS、有创机械通气、无创机械通气及多巴胺治疗的比例高于non-IVH组(P<0.05),且logistic分析结果显示,产前激素及硫酸镁治疗、剖宫产分娩、GA≥32周、BW≥1500 g为NICU早产儿发生IVH的保护性因素(P<0.05),胎盘早剥、EOS、代谢性酸中毒、多巴胺治疗、凝血功能异常、产时窒息、贫血、NRDS、无创及有创机械通气为NICU早产儿IVH发生的危险因素(P<0.05);严重IVH组早产儿产前硫酸镁治疗比例、GA、BW低于轻度IVH组(P<0.05),凝血功能异常、EOS、无创及有创机械通气比例高于轻度IVH组,且logistic分析结果显示,GA≥32周、BW≥1500 g是IVH早产儿发生严重IVH的保护性因素(P<0.05),EOS、凝血功能异常为危险因素(P<0.05)。结论加强产前�Objective To investigate the occurrence of intraventricular hemorrhage(IVH)in premature infants in neonatal intensive care unit(NICU)and the factors influencing its severity.Methods A total of 150 premature infants in the NICU were divided into IVH group(n=80)and non-IVH group(n=70).IVH group was further classified into mild IVH(GradeⅠ-Ⅱ,n=65)and severe IVH(GradeⅢ-Ⅳ,n=15)based on the severity of hemorrhage.Clinical data from all preterm infants and their mothers were collected,including:prenatal factors(whether the mothers had a concomitant hypertension during pregnancy,use of magnesium sulfate,use of steroids during foot therapy,placental abruption,whether the fetuses had intrauterine distress,intrauterine infection and umbilical cord abnormalities),delivery modes,postpartum situation[birth asphyxia,gestational age(GA),birth weight(BW),and gender],comorbidities[cephalhematoma,neonatal respiratory distress syndrome(NRDS),metabolic acidosis,hypoglycemia,early-onset sepsis(EOS),coagulation functional abnormalities,and anemia],therapies(mechanical ventilation and vasoactive drug use)and cranial ultrasound findings during hospital stay(whether there was IVH presence and IVH severity).Logistic regression was used to analyze the factors affecting the occurrence and the severity of IVH in premature infants.Results The proportions of GA,BW,cesarean section,prenatal hormone,and magnesium sulfate treatment in NICU were lower in IVH group than those in non-IVH group(P<0.05).The proportions of placental abruption ratio,birth asphyxia,metabolic acidosis,anemia,coagulation abnormalities,NRDS,EOS,invasive mechanical ventilation,non-invasive mechanical ventilation,and dopamine treatment were higher in IVH group than those in non-IVH group(P<0.05).Logistic regression showed that prenatal hormone,magnesium sulfate treatment,cesarean section delivery,GA≥32 weeks,and BW≥1500 g were protective factors for IVH in NICU premature infants(P<0.05),and placental abruption,EOS,metabolic acidosis,dopamine therapy,coagulation func
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