早产儿视网膜病变激光光凝术后不良反应发生情况及其影响因素

目的：探讨早产儿视网膜病变（ROP）激光光凝术后不良反应发生类型、出现时间及其影响因素，为采取有效措施预防ROP激光光凝术后不良反应提供依据。方法：选择行激光光凝术的ROP患儿64例，按照光凝术后有无出现呼吸暂停、坏死性小肠结肠炎、败血症和消化道出血等不良反应分为不良反应组（n=26）和无不良反应组(n=38)，分析不良反应组患儿不良反应出现时间，比较2组患儿术前白细胞(WBC)、血红蛋白(Hgb)、血小板(PLT)、C反应蛋白(CRP)
水平及眼底筛查次数、术时体质量、激光点数、麻醉方式等影响因素。结果：光凝术后38例患儿无不良反应（59.4%），26例患儿出现不良反应（40.6%）。不良反应包括坏死性小肠结肠炎14例（53.8%）、呼吸暂停6例（23.1%）、败血症4例（15.4%）、消化道出血2例（7.7%），不良反应出现时间为术后（3.05±1.95） d。2组患儿术前WBC、Hgb、PLT、CRP水平、激光点数和纠正胎龄比较差异均无统计学意义（P>0.05）。不良反应组患儿眼底筛查次数
多于无不良反应组（P<0.05)，术时体质量低于无不良反应组（P<0.05)；无不良反应组10例（26.3%)患儿行全身麻醉，不良反应组中有4例患儿行全身麻醉（15.4%），无不良反应组患儿行全身麻醉率高于不良反应组（χ2=3.265，P<0.05)。结论：呼吸暂停、坏死性小肠结肠炎、败血症
和消化道出血均为激光光凝术后常见的不良反应，筛查次数多和术时体质量较低是光凝术后不良反应出现的高危因素，全身麻醉后实施激光光凝术可减少不
良反应的发生。
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Side effects after laser photocoagulation for retinopathy of prematurity and their risk factors

Abstract:Objective To study the variety, appearing time and risk factors of side effects after laser photocoagulation for retinopathy of prematurity (ROP) infa
nts and to provide basis for effectively preventing the side effects.Methods 64 ROP infants with stage 3threshold lesion were selected and divided into side effect group(n=26) andnon-side effect group (n=38) according to whether any side effects such as apnea,necrotizing enterocolitis(NEC),sepsis and gastrointestinal hemorrhage accompanied.The WBC,Hgb,PLT,CRP level, screening times, laser points,weight,corrected gestat
ional ageand anaesthesia style were compared between two groups. Results 38 (59.4%) infants had no side effect after laser photocoagulation,but 26 (40.6%) infants had side effects including NEC(53.8%), apnea(23.1%),sepsis(15.4%)and gastrointestinal hemorrhage (7.7%);the side effects appeared on the (3.05±1.95) d after photocoagulation.The WBC,Hgb,PLT,CRP level, laser points and corrected gestationalage had no significant difference between two groups(P>0.05). However, thescreeningtimes in side effect group were more than that in non-side effect group（P<0.05) and the weight was less than in non-side effect group（P<0.05). The rateof general anesthesia in non-side effect group(26.3%) was higher than that in side effect group(15.4%)(P<0.05).
Conclusion Apnea, necrotizing enterocolitis,sepsis and gastrointestinal hemorrhage are the most common side effectsafter laser photocoagulation. More screen times and less weight are the risk factors of side effects. General anesthesia could help decrease the side effect of laser photocoagulation.
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