红细胞增多症影响早产儿视网膜病变的临床观察

目的 观察红细胞增多症对早产儿视网膜病变(ROP)的影响.方法 回顾分析262例早产儿的临床资料.患儿中红细胞增多症46例,占17.56%;其中,男性27例,女性19例.无红细胞增多症216例,占82.46%;其中,男性155例,女性61例.有无红细胞增多症两组患儿在出生体重(t=0.730,P=0.466)、胎龄(t=1.603,P=0.110)、吸氧人数(χ1=0.04,P>0.90)、吸氧时间(t=1.225,P=0.223)、吸氧浓度(t=1.823,P=0.071)之间比较,差异均无统计学意义.所有受检早产儿均由有经验的服科医生采用双目间接检眼镜检查眼底,确定有无ROP并进行分期.回顾分析时,着重分析有无红细胞增多症与ROP发生和分期之间的相互关系.结果 262例早产儿中发生ROP 120例,占45.80%.其中,红细胞增多症组发生ROP 25例,占红细胞增多症患儿的54.34%;无红细胞增多症组发生ROP 95例,占无红细胞增多症患儿的43.98%.有无红细胞增多症两组ROP发生率比较,差异无统计学意义(χ2=1.64,P>0.1).120例ROP患儿中,ROP<3期者104例,占86.67%;≥3期者16例,占13.33%.25例发生ROP的红细胞增多症患儿中,ROP<3期者18例,占发生ROP的红细胞增多症患儿的72.00%;≥3期者7例,占发生ROP的红细胞增多症患儿的28.00%.95例发生ROP无红细胞增多症患儿中,ROP<3期者的86例,占发生ROP的无红细胞增多症患儿的90.53%;≥3期者9例,占发生ROP的无红细胞增多症患儿的9.47%.有无红细胞增多症两组间在<3期和≥3期ROP发生率之间比较,差异有统计学意义(x2=4.38P<0.05).120例ROP患儿中,阈值前病变106例,占88.33%;阈值及以上病变14例,占11.67%.25例发生ROP的红细胞增多症患儿中,阈值前病变19例,占发生ROP的红细胞增多症患儿的76.00%;阈值及以上病变6例,占发生ROP的红细胞增多症患儿的24.00%.95例发生ROP无红细胞增多症患儿中,阈值前病变87例,占发生ROP的无红细胞增多症息儿的91.58%;阈值及以上病变8例,占发生ROP的无红细胞增多症患儿的8.42%.有无红细胞增多症两组间阈值前病变和阈值及以上病变ROP发生率比较,差异无统计学意义(χ2=3.27,P>0.05).结论 红细胞增多症不影响ROP发生率,但可能影响ROP的严重程度.     

早产儿视网膜病变发病情况分析

目的 分析早产儿视网膜病变(ROP)的发病情况.方法 回顾性分析2005年9月至2008年5月来就诊的胎龄小于36周、体重低于2500g的210例早产儿的眼底筛查情况及高危因素.结果 210例早产儿中,ROP的发生率为12.9%,其中ROP3期以上的发生率为3.8%;低孕周、低体重、出生后吸氧时间过长、严重的新生儿疾病的早产儿ROP发生率高;双生子ROP发生率(20.5%)高于单生子(10.8%),且ROP发生严重.结论 低孕周、低体重、出生后吸氧时间过长、患严重的新生儿疾病、非单生子等是引起早产儿视网膜病变的高危因素.     

早产儿视网膜病变145例转归情况及影响因素分析

目的:分析早产儿视网膜病变(ROP)的转归情况,了解影响ROP转归的因素。方法:2011-09/2012-09我院新生儿监护病房住院诊断为ROP的患儿共145例,其中男110例,女35例,记录其转归情况,对手术组与非手术组的孕周、出生体质量、吸氧时间、吸氧方式(持续正压通气(CPAP)或机械通气)、肺表面活性物质应用、败血症进行统计学分析。结果:早产儿视网膜病变145例为1～3期患儿,无1例4～5期病变,36例(24.8%)行视网膜光凝或(和)冷凝,109例(75.2%)患儿完全自然退变或阈值前病变病情稳定未手术。采用卡方检验单因素分析及多因素Logistic回归分析,结果表明孕周、吸氧时间、CPAP或机械通气及败血症与ROP转归有关,差异有统计学意义。孕周、吸氧方式、败血症是ROP病情进展的相关因素,组间差异有统计学意义。结论:ROP大部分可自行退变或病情稳定不需手术,小孕周、机械通气或CPAP、吸氧时间长、败血症可加重病情,增加手术机率。     

RetCamⅡ在新生儿眼底病变筛查中的应用

目的: 探讨新生儿眼底病变安全可靠的检查方法。方法: 回顾总结我院2012-01-01/12-31采用RetCamⅡ广域视网膜成像系统检查的2836例新生儿眼底病变的情况。其中早产儿1625例(57.30%),第一次检查时间为出生后1～4wk,矫正胎龄32～40wk。足月儿1211例(42.70%)。第一次检查时间为生后4wk内。结果: 筛查出454例眼底异常,其中早产儿视网膜病变(ROP)207例(占早产儿比例12.74%),包括ROPⅠ期118例(57%),ROPⅡ期58例(28.02%),ROPⅢ期23例(11.11%),ROPⅣ期8例(3.86%),ROPV期0例;足月新生儿眼底病变247例(占足月儿比例20.40%),其中发育性、遗传性疾病68例,占27.53%;视网膜母细胞瘤1例,占0.40%;视网膜出血102例,占41.30%;视网膜渗出68例,占27.53%;视神经萎缩5例,占2.02%;视盘水肿3例,占1.21%。结论: 新生儿眼底病变多样且危害严重,应重视早期筛查,早产儿及伴有高危因素的足月儿应该是眼底筛查的重点人群,使用RetCamⅡ数字视网膜照相机进行新生儿眼底病变检查是安全有效的手段。     

秦皇岛地区早产儿视网膜病变筛查情况分析

目的分析秦皇岛地区早产儿视网膜病变(ROP)的发病情况。方法回顾性分析胎龄小于37周或体重低于2500g的616例早产儿Ret Cam III眼底筛查情况。结果 616例早产儿中,ROP的年发病率为7.63%,其中ROP3期以上的发病率为1.1%。结论秦皇岛地区早产儿视网膜病变的发病率与欧美国家、台湾及北京地区ROP发病率低。出生体重、胎龄为早产儿视网膜病变发生的重要危险因素。     

早产儿视网膜病变筛查和阈值期治疗的研究

目的研究早产儿视网膜病变(ROP)的发生率,评估ROP阈值期治疗效果。方法使用双目间接检眼镜对108例早产儿进行ROP筛查,将筛查结果进行统计学分析,达到阈值病变的患儿及时进行视网膜激光光凝或经巩膜、视网膜冷凝术。结果筛查108例早产儿,发现ROP23例,发生率为21.3%。在所有ROP患儿中,ROP1期13例,占56.5%;ROP2期3例,占13.0%;ROP3期7例,占30.4%。其中ROP3期患儿均伴有附加病变,达到阈值病变标准。ROP患儿出生体重为(1.43±0.25)kg(t=4.059,P<0.001);孕周为(31.0±2.3)周(t=2.637,P=0.013);吸氧时间为1~49d,平均17d(n=23,Z=-3.630,P<0.001);需要机械辅助呼吸患儿18例(χ2=12.009,P=0.001);上述指标与非ROP患儿比较,差异均有统计学意义;而与是否多胎的差异无统计学意义(χ2=1.013,P=0.314)。Logistic回归分析:出生体重低(β=-2.542,OR=0.079,P=0.032)和使用机械辅助呼吸(β=1.341,OR=3.823,P=0.025)的患儿是发生ROP的相关高危因素。7例阈值期病变患儿中,6例进行激光光凝或冷凝治疗。术后随访2个月至2年,手术眼的结构和视功能未见异常。1例阈值期病变患儿未予治疗,于1个月后出现视网膜脱离。结论出生体重轻、孕周少、吸氧时间长、需要机械辅助呼吸的早产儿发生ROP的风险较高。对阈值期病变患儿应及时进行激光光凝或冷凝治疗。     

早产儿视网膜病变的早期干预

目的通过开展早产儿视网膜病变（ROP）的筛查工作,强调对早产儿视网膜病变的早期干预。方法对住院85名出生体重低于或等于2500g,胎龄少于或等于32w的早产儿或患有全身疾病的早产儿进行常规的眼部检查。对于发生ROP的患儿,每2w复查眼底,直至视网膜正常血管化或ROP发生退行性改变;如发现ROP阀值病变的患儿,则立即行激光光凝治疗。结果85名早产儿发现有早产儿视网膜病变者14例,占16.44%,其中ROPⅠ期8例,Ⅱ期3例,Ⅱ期＋3例。本组资料中,出现ROP的早产儿均为出生体重≤2000g,高浓度氧疗（〉40%）持续5d以上。发现早产儿出现ROP,经过调整氧疗的浓度及氧疗的时间,从而控制了ROP病情的发展恶化。结论严格把握ROP的筛查标准,控制氧疗的浓度和治疗时间,是防治ROP的关键所在。ROP的筛查工作依靠儿科医师与眼科医师的密切配合,针对ROP的危险因素进行早期干预,才能有效地控制ROP的发生、发展,防止ROP的致盲。     

妊娠期高血压综合征治疗中眼底观察的临床意义

目的:探讨妊娠期高血压综合征患者眼底观察的临床意义。方法:对妊娠期高血压疾病患者产前、产后的眼底观察情况进行分析。结果:患者599例中眼底正常152例(25.4%),眼底改变447例(74.6%),其中妊娠期高血压眼底改变率为63.9%,子痫前期轻度眼底改变率为80.4%,子痫前期重度眼底变率为98.8%,子痫眼底改变率为100%,视网膜病变III期69例中12例合并视网膜脱离。视网膜病变发病率及严重程度与妊娠期高血压综合征疾病程度成正比,血压越高,蛋白尿越高,红细胞压积越高,视网膜病变发生率越高。产后子痫,与重度妊娠期高血压合并视网膜病变有关。结论:眼底观察对判断妊娠期高血压综合征病情程度,制订治疗方案,对防止产后子痫及防止严重视网膜病变都具有重要意义。     

早产儿视网膜病变发病情况分析

目的回顾性分析2004年7月至12月我院早产儿视网膜病变(ROP)的发病情况。方法对2004年7月至12月出生的89例体重2000g以下或孕周小于34周的早产儿,自生后4~6周或矫正胎龄32周开始筛查至周边视网膜血管化。结果89例早产儿有9例发生了早产儿视网膜病变,占10.11%,其中严重的3例接受了激光治疗,占3.37%。结论出生体重、胎龄为早产儿视网膜病变发生的重要危险因素,婴儿出生的成熟度越低,早产儿视网膜病变尤其是严重的早产儿视网膜病变发病可能性越高。     

广州市番禺区670例早产儿视网膜筛查结果报道

目的 了解早产儿视网膜发育特点及眼底病变发生情况.方法 用带视频录像的双目间接眼底镜对番禺区670例早产儿进行眼底检查,观察视网膜发育及其眼底病变的发生情况.结果 (1)正常早产儿眼底表现:大部分视盘欠圆,色淡,边界欠清,视杯不明显.后极部视网膜动静脉血管条纹及其次级分支清晰可见.黄斑部轮晕明显,范围大,光反射强,大部分黄斑中心凹不明显.(2)眼底病变发生情况:发现ROP者8例,发病率为7.1％;其中,ROP1期者2例,2期者2例,3期者4例,未发现4期及5期病变.视网膜出血发生11例,均为自然分娩患儿.玻璃体病变3例.(3)并发症发生情况:21例患儿发生不同程度的球结膜下出血,2例患儿头皮下见大量出血点,1例患儿发生急性结膜炎.在检查前后过程中未发现有呼吸暂停、休克等严重并发症.结论 基层医院早产儿胎龄、体重、ROP发病率、ROP严重程度等方面与三级医院有较大差异.在基层医院普及筛查制度,可以避免绝大部分严重致盲ROP发生,具有重大意义.     

The prognostic significance of shape of demarcation line and ridge in clinical course of active phase of retinopathy of prematurity

PURPOSE: We planed out a comparison of clinic significance between eyes with acute ROP with "bays" and ROP without "bays". Retinopathy of prematurity (ROP) is a main reason of blindness in premature babies. There are no studies about shape of demarcation line and ridge in acute retinopathy of prematurity and its influence for clinical significance of ROP. In 11.42% of eyes with acute ROP we observed irregularities of demarcation line and ridge, which we called "bays". MATERIAL AND METHODS: We observed 140 premature babies (280 eyes) with acute ROP. In 32 eyes (11.42%) we stated "bays". We compared progression to stage ROP3c between group I (eyes with acute ROP and "bays") and group II (eyes with ROP without "bays). RESULTS: In 87.5% eyes with "bays" we observed progression to stage 3 c retinopathy of prematurity. In group without "bays" progression to stage 3c was observed only in 33.47%. CONCLUSIONS: We suppose, that presence of "bays" of demarcation line and ridge brings about worse prognosis at the course of acute retinopathy of prematurity.     

Retinopathy of prematurity. Results of fundus examination performed in 94 preterm infants

PURPOSE: The purpose of this study was to evaluate the incidence and severity of retinopathy of prematurity (ROP) in infants of birth weight less than 1.500 g and/or under 32 weeks'gestation. METHODS: Ninety-four preterm infants were examined following the Royal College of Ophthalmologists guidelines and retinopathy was graded using the International Classification of ROP. Screening limits were 1 500 g birth weight or 32 weeks'gestational age. Fundus examinations for ROP were performed at 5 weeks'chronological age from birth. Pupil dilation was obtained with instillation of 1% tropicamide three times at 15-minute intervals. RESULTS: The 94 infants examined for ROP had a median gestational age of 292.3 weeks and a median birth weight of 1 110340 g. ROP was diagnosed in 21 of 94 subjects (22.3%) by fundus examination. ROP stage 3 developed in one preterm infant, ROP stage 2 developed in five preterm infants, and ROP stage 1 developed in 15 preterm infants. No premature babies developed stage 4 or stage 5 ROP. The disease regressed spontaneously in all cases and none of the infants required cryo/laser therapy. In the most premature infants, 23-26 weeks'gestation, 57% developed ROP and one developed severe ROP (stage 3). No disease more posterior to peripheral zone 2 was observed. The incidence of ROP was higher in infants exposed to greater than 21% oxygen (24.2%) than in infants who did not receive oxygen (17.8%). Oxygen, blood transfusion, and cardiopathy appear to be associated with an increased incidence of retinopathy of prematurity. CONCLUSIONS: ROP continues to be a common problem associated with prematurity in France. This study found a similar incidence of prethreshold ROP when compared to recent studies. The data showed that blood transfusion and cardiopathy may play a role in the development of ROP in premature infants.     

Thrombocytopenia and retinopathy of prematurity

BACKGROUND: Platelets may act as vascular endothelial growth factor (VEGF) scavengers, possibly limiting neovascularization in retinopathy of prematurity (ROP). The purpose of this study was to investigate the association between thrombocytopenia (platelets <150,000/μL) and the development of type 1 ROP. METHODS: This was a retrospective 1:1 matched case-control study. Cases required laser; controls developed no or stage 1 ROP and were matched for birth weight within 100 g and gestational age within 1 week. Most recent platelet count prior to laser (case) and matched postmenstrual age (control) were abstracted. Conditional logistic regression was used. RESULTS: A total of 91 cases and 91 controls were reviewed. Of the cases, 25% had thrombocytopenia; of controls, 13% (P = 0.034; OR = 2.38; 95% CI, 1.04-5.43). Birth weight, gestational age, postmenstrual age, and culture-proven sepsis were not confounders in multivariate analysis. The association was significant for zone 1 (n = 16; OR = 9.00; 95% CI, 1.14-71.0) but not for zone 2 (OR = 1.43; 95% CI, 0.54-3.75) cases and controls. CONCLUSIONS: Thrombocytopenia was associated with type 1 ROP, primarily among infants with zone 1 ROP. This effect may result from disease location or disease timing, as posterior disease occurs at an earlier postmenstrual age. Longitudinal studies are required to further examine the roles of cumulative platelet deficits, thresholds, or critical time windows in the observed association.     

Retinopathy of prematurity in Toyama area of Japan

This study attempted to establish the incidence and severity of retinopathy of prematurity (ROP) at a neonatal intensive care unit in Toyama, Japan. The fundi of infants with low birth weights were examined weekly. Retinopathy was found in 82 (55.8%) of 147 infants. Of these infants, 38 had stage 1 ROP, according to the International Classification of ROP; 15, stage 2; 27, stage 3; 1, stage 4; and 1, stage 5.     

西安地区早产儿视网膜病变筛查的初步结果

目的 探讨适合西安地区早产儿视网膜病变(ROP)的筛查标准并分析与ROP相关的高危因素.方法 回顾性系列病例研究.收集西安地区2008年6月至2009年6月134例(268只眼)早产儿和低体重儿ROP筛查资料进行回顾性分析.参照我国卫生部制定的ROP筛查标准,结合本地具体情况,适度扩大筛查范围,将出生体重≤2000 g或矫正胎龄≤34周的早产儿和低体重儿确定为本地区ROP筛查标准,并比较分析两个筛查标准所获结果.检查同时对受检儿全身情况进行评估与记录,分析ROP发生的全身高危因素.ROP患儿组与眼底正常儿组的出生孕周和出生体重比较,采用组间比较t检验;两组受检儿中有持续吸氧史者所占比例的比较,采用四格表资料的χ~2检验;ROP与全身相关因素的分析,采用Fisher精确检验.以P<0.05作为差异有统计学意义.结果 西安地区134例(268只眼)早产儿和低体重儿中,共筛查出18例(36只眼)患有不同程度的ROP,ROP检出率约为13.43%.其中男、女性各9例;出生孕周28～34周,平均(30.58±1.97)周;出生体重880～1950 g,平均(1388.89±268.39)g.18例ROP患儿均为双眼患病,其中ROP 1期4例(8只眼);ROP 2期5例(10只眼),其中1例病变侵及Ⅱ区且伴附加病变;ROP 3期伴附加病变5例(10只眼);ROP 4 A期1例(2只眼);ROP 5期1例(2只眼);退行性病变2例(4只眼).按照卫生部制定的ROP筛查标准,西安地区134例早产儿和低体重儿中,仅108例需要筛查,可以涵盖所有ROP患儿,ROP检出率约为16.67%(18/108).在接受筛查的134例早产儿和低体重儿中,眼底正常儿组的平均出生孕周为(32.56±2.00)周,平均出生体重为(1773.91±349.73)g,均明显高于ROP患儿组,差异有统计学意义(孕周t=3.90,P<0.01;体重t=4.45,P<0.01);眼底正常儿组与ROP患儿组有持续吸氧史者所占比例分别为59.48%和61.11%,差异无统计学意义(χ~2=0.017,P>0.05);缺血和缺氧性脑病及胎盘早剥在眼底正常儿组与ROP患儿组的比例分别为12.07%与33.33%(P=0.030)和0.86%与11.11%(P=0.047),差异有统计学意义;结果表明早产、低出生体重、缺血和缺氧性脑病、胎盘早剥等影响胎儿发育的相对缺氧因素与ROP的发生密切相关.结论 西安地区ROP检出率与国内其他地区报道的数据相近.我国卫生部制定的ROP筛查标准适合西安地区的ROP筛查工作.早产、低出生体重及相对缺氧因素是ROP发生的高危因素.     

Retinopathy of prematurity in infants with birth weight>or=1250 grams-incidence, severity, and screening guideline cost-analysis.

PURPOSE: To determine the incidence and severity of retinopathy of prematurity (ROP) in infants with birth weight (BW) 1250 to 1800 g, to examine the influence of systemic conditions on the development of ROP in this population, and to evaluate the cost-effectiveness of various screening guidelines. METHODS: We reviewed records from 259 consecutive infants with BW 1250 to 1800 g who were screened for ROP over a 3-year period. Extracted data included presence and severity of ROP, and the following potential risk factors (RF) for ROP development: sepsis, meningitis, necrotizing enterocolitis, intraventricular hemorrhage greater than stage I, pneumothorax, direct bilirubin>2 mg/dl, central line placement, antibiotic treatment>14 days, greater than seven red blood cell (RBC) transfusions, and mechanical ventilation>96 hours. RESULTS: The overall incidence of ROP in this population was 4.2%. Two infants had stage 3 ROP, one with plus disease. Infants with stage 3 ROP had significantly lower BW (1299 versus 1484 g, P=0.013) and gestational age (GA) (28 versus 31 weeks, P=0.002) than those with no ROP. No infant with BW>1500 g developed treatable ROP. Conditions that best predicted ROP development in the 1501 to 1800 g BW group were sepsis, ventilation >96 hours, antibiotic use >14 days, RBC transfusions greater than seven units, and central line placement (P=0.001, P=0.001, P=0.012, P=0.014 and P=0.035, respectively). All infants with BW>1500 g who developed ROP had greater than or equal to two of these RF. CONCLUSIONS: All cases of high-risk ROP would have been identified by current screening guidelines. Modified screening criteria of infants with (1) BW相似文献   

Poor postnatal weight gain: A risk factor for severe retinopathy of prematurity

PURPOSE: This study aimed to investigate the relationship between rate of postnatal weight gain and severity of retinopathy of prematurity (ROP). METHODS: All infants (n = 111) screened for ROP at a single tertiary intensive care nursery over a 2-year period with an estimated gestational age of 30 weeks or less and follow-up to at least 42 weeks' postconception were included. The authors performed a retrospective review of records and statistical analysis of risk factors for ROP using multivariate analysis. RESULTS: Infants with severe (stage 3 or greater) ROP gained an average 10.9 g/kg per day in the first 6 weeks of life, compared to a mean of 9.6 g/kg per day for those with mild or no ROP (P =.04). By multiple regression, which included birth weight, gestational age, and 9 other reported risk factors, there was an association between rate of postnatal weight gain and severity of ROP (P =.02). By stepwise regression, 4 variables were associated with ROP severity: estimated gestational age at birth (P =.002), rate of postnatal weight gain (P = .0002), volume of transfused erythrocytes (P =.0001), and culture-proven sepsis (P = .02). CONCLUSION: Poor postnatal weight gain is a risk factor for the development of severe (stage 3 or greater) ROP. Ophthalmologists should take note of those infants who gain less than 50% of their birth weight in the first 6 weeks of life.     

Retinopathy of prematurity in surfactant treated infants.

Seventy six babies of less than 1500 g birth weight who had surfactant replacement therapy for severe respiratory distress syndrome were studied to assess the presence and stage of subsequent retinopathy of prematurity (ROP). A control group of 90 babies, matched for birth weight and gestational age, who did not have surfactant therapy were also studied. Threshold ROP or greater was found in 1.7% of the surfactant group and 7.8% of the controls. For the babies of less than 1000 g birth weight 4.0% of the surfactant babies and 16.3% of the controls reached threshold disease or greater. It is concluded that surfactant therapy is not associated with an increased incidence or severity of severe ROP in this preterm population.     

高危阈值前和阈值病变早产儿视网膜病变激光光凝治疗疗效分析

目的 观察激光光凝治疗高危阈值前和阈值病变早产儿视网膜病变（ROP）的临床疗效和安全性。方法 临床检查确诊的97例ROP患儿186只眼纳入研究。其中,高危阈值病变88只眼,阈值病变98只眼。186只眼中,1区病变70只眼,2区病变116只眼。所有患儿均在全身麻醉下采用波长为810 nm的Iridis激光机经双目间接检眼镜输出进行激光光凝治疗。治疗后随访35～852 d,平均随访时间(316±274) d。观察病变完全消退和病变进展情况。结果 186只眼中,病变完全消退168只眼,占90.3%;出现局部纤维增生10只眼,占5.4%;进展为局限性视网膜脱离8只眼,占4.3%。高危阈值病变组88只眼中,病变完全消退84只眼,占95.5%;病变进展4只眼,占4.5%。阈值病变组98只眼中,病变完全消退84只眼,占85.7%;病变进展14只眼,占14.3%。两组病变完全消退率比较,差异有统计学意义（χ2=3.98,P＜0.05）。1区病变70只眼中,病变消退56只眼,占80.0%;病变进展14只眼,占20.0%。2区病变116只眼中,病变消退112只眼,占96.6%;病变进展4只眼,占3.4%。1区病变进展眼数明显高于2区病变进展眼数,差异有统计学意义（χ2=11.86,P＜0.01）。未观察到与治疗相关的并发症。结论激光光凝治疗高危阈值前和阈值病变ROP均有较好疗效,提前干预能减少其不良预后;无与治疗相关的并发症发生。