极低出生体重儿脑室周围-脑室内出血的相关因素

目的　了解围产因素与极低出生体重儿 (VL BW)脑室周围 -脑室内出血的相关性 ,从而产生预见性价值。　方法　对 4 12例住院的 VL BW定期头颅 B超检查 ,对合并出血进行分级。应用逐步 L ogistic回归分析法寻找脑室周围 -脑室内出血和重度脑室内出血的预测因素。　结果　 4 12例VL BW脑室周围 -脑室内出血发生率为 2 5 .0 % (10 3/ 4 12 ) ,病死率为 39.8% (41/ 10 3)。合理干预后 ,其发生率从 1994年的 32 .0 %逐渐下降 ,2 0 0 0年为 17.6 %。胎龄小、体重低发生率较高。通过对相关因素多变量分析得出导致脑室周围 -脑室内出血独立预测因素分别为围产期窒息 (5 min Apgar评分 <5分 ) :比值比 (OR)为 2 .4 6 ,95 %可信区间为 1.4 8,4 .4 2 ;胎龄小于 2 9周 :OR为 2 .37,95 % ,可信区间为1.35、3.6 8;重度呼吸窘迫综合征 :OR为 2 .16 ,95 %可信区间为 1.34、4 .19;阴道分娩 :OR为 2 .14 ,95 %可信区间为 1.2 5、3.6 8。导致重度脑室内出血的独立预测因素是气胸 :OR为 2 .70 ,95 %可信区间为 1.12、6 .5 7;平均出生体重小于 95 6 g:OR为 4 .0 2 ,95 %可信区间为 1.15、4 .12。　结论　采取合理干预措施有利于避免脑室周围 -脑室内出血的发生和发展

Factors Associated with Periventricular-intraventricular Haemorrhage in the Very Low Birth Weight Infants

Objective To establish the predictive value of perinatal factors associated with periventricular intraventricular haemorrhage (PIVH). Methods All very low birth weight infants underwent real time ultrasonography of the brain. The haemorrhages were graded to make use of stepwise logistic regression analyses to search predictive factors of PIVH and severe intraventricular haemorrhage. Results The incidence of PIVH of 412 very low birth weight infants was 25.0% (103/412), the mortality rate of PIVH was 39.8% (41/103). The incidence of PIVH by year was declining from 32.0% in 1994 to 17.6% in 2000 through the formulation of rational interventions. Infants who were of lower gestational age and lower birth weight had a higher incidence of PIVH and more severe intraventricular haemorrhage. Correlated factors were subjected to multivariate analysis. The predictive factors were perinatal asphyxia (OR 2.46,95% CI 1.48,4.42), gestation of less than 29 weeks (OR 2.37,95% CI 1.35,3.68),severe respiratory distress syndrome (OR 2.16,95% CI 1.34, 4.19),vaginal delivery (OR 2.14, 95% CI 1.15, 4.12). Conclusion Some intervention like prevention of low birth weight infant may reduce the incidence of periventricular intraventricular haemorrhage.