极低出生体重儿脑室周围-脑室内出血高危因素分析

目的　探讨极低出生体重儿（VLBWI）脑室周围-脑室内出血（PVH-IVH）的高危因素。方法　回顾性对照分析2009年10月至2010年11月青岛大学医学院附属医院VLBWI 117例病例，PVH-IVH 39例为PVH-IVH组，按胎龄、出生体重1 ∶ 2配对的无PVH-IVH 78例为对照组，对其相关因素采用SAS 9.0软件进行配对条件Logistic 回归分析。结果　130例VLBWI中发生PVH-IVH 39例，发生率为30.00%。应用1 ∶ 2配对的条件Logistic回归分析示经阴分娩（OR = 1461.699，CI 7.216～296094.700，P < 0.0001）、胎儿宫内窘迫（OR = 95.172，CI 2.213～4093.612，P = 0.0006）、机械通气（OR = 65.124，CI 2.258～1878.432，P = 0.0228）、动脉导管未闭（PDA）（OR = 42.051，CI 1.935～913.839，P = 0.0283）、低钠血症（OR = 33.415，CI 0.936～1192.593，P = 0.0475）、低钙血症（OR = 25.175，CI 1.328～477.243，P = 0.0325）是VLBWI发生PVH-IVH的高危因素；产前使用激素（OR = 0.061，CI 0.004～0.884，P = 0.0017）是避免患儿发生PVH-IVH的保护因素。结论　经阴分娩、胎儿宫内窘迫、机械通气、PDA及电解质紊乱是VLBWI发生PVH-IVH 的高危因素，而产前使用激素可预防PVH-IVH的发生，因此PVH-IVH的发生是多种因素相互作用的复杂结果。在围生期工作中应当高度重视这些因素，以提高早产儿的生存质量。

Risk factors for periventricular-intravenricular hemorrhage in very low birth weight infants.

Abstract： Objective　To investigate the high risk factors for periventricular-intraventricular hemorrhage （PVH-IVH） in very low birth weight infants（VLBWI）. Methods　From October 2009 to November 2010 in Hospital of Medical College，Qingdao University，39 VLBWI diagnosed with PVH-IVH were reviewed，and the control group consisted of 78 VLBWI without PVH-IVH，who were matched for gestational age and birth weight to each case of PVH-IVH. The data of 117 VLBWI were analyzed by 1 ∶ 2 conditional Logistic regression analysis of SAS 9.0. Results　Totally 39 of 130 VLBWI were found to have PVH-IVH，indicating an incidence of 30.00%. The 1 ∶ 2  conditional Logistic regression analysis showed that vaginal delivery（OR = 1461.699，CI 7.216～296094.700，P < 0.0001），intrauteral embarrassment（OR = 95.172，CI 2.213～4093.612，P = 0.0006），mechanical ventilation（OR = 65.124，CI 2.258～1878.432，P = 0.0228），patent ductus arteriosis （PDA） （OR = 42.051，CI 1.935～913.839，P = 0.0283），hyponatremia（OR = 33.415，CI 0.936～1192.593，P = 0.0475 and hypocalcemia（OR = 25.175，CI 1.328～477.243，P = 0.0325）were the main risk factors for PVH-IVH in VLBWI，and antenatal steroid treatment（OR = 0.061，CI 0.004～0.884，P = 0.0017）was the protective factor. Conclusion　Vaginal delivery，intrauteral embarrassment，mechanical ventilation，PDA and the electrolyte disturbances were the risk factors for PVH-IVH in VLBWI，and antenatal steroid treatment could protect the VLBWI from PVH-IVH，suggesting that PVH-IVH results from the reaction of many factors. These findings can be used to improve the quality of premature infants.