极低和超低出生体重儿严重脑损伤的高危因素及预后分析

目的:分析极低和超低出生体重儿严重脑损伤的高危因素及预后。方法:以收治的151例极低和超低出生体重儿为研究对象,其中21例严重脑损伤为病例组,其余130例为对照组,比较两组患儿的胎龄、出生体重、窒息、低氧血症、高碳酸血症和机械通气的比例,并比较两组患儿死亡率及脑性瘫痪、癫痫发生率和存活者智测情况。结果:病例组胎龄及出生体重显著小于对照组(P<0.01),窒息、低氧血症、高碳酸血症和机械通气的比例显著高于对照组(P<0.01),死亡率及脑性瘫痪、癫痫发生率显著高于对照组,差异均有统计学意义(P<0.01);病例组存活者NBNA评分、生后6个月及1岁CDCC评分显著低于对照组,差异有统计学意义(P<0.01)。结论:小胎龄和低体重是极低和超低出生体重儿严重脑损伤的高危因素,窒息、低氧血症、高碳酸血症和机械通气均可加重极低和超低出生体重儿脑损伤,严重脑损伤可导致死亡率显著升高,存活者预后不良。

Analysis of high risk factors and prognosis of very low birth weight infants and extremely low birth weight infants with severe cerebral injury

Objective To analyze high risk factors and prognosis of very low birth weight infants and extremely low birth weight infants with severe cerebral injury.Method There were 151 very low birth weight infants and extremely low birth weight infants from January 2009 to December 2011,21 infants with severe cerebral injury as case group,the other 130 infants as control group.The gestational ages,birth weights,asphyxia,hypoxia,hypercapnia,mechanical ventilation,mortality,cerebral palsy,epilepsy,and intelligence tests of the survivors were compared between the two groups.Results The gestational ages and the birth weights of case group were less than those of control group(P<0.01).The ratios of asphyxia,hypoxia,hypercapnia,mechanical ventilation was significantly more than those of control group(P<0.01).The mortality,the morbidity of cerebral palsy,epilepsy is more than those of control group(P<0.01).The NBNA scores,the CDCC scores of the infants born after 6 months and 1 year of case group were significantly less than those of control group(P<0.01).Conclusion The lower gestational age and the lower birth weight are high risk factors of the very low birth weight infants and the extremely low birth weight infants with severe cerebral injury.Asphyxia,hypoxia,hypercapnia,mechanical ventilation may aggravate the injury.The infants with severe cerebral injury may have high mortality and the survivors may have poor prognosis.