早产极低出生体质量儿脑室周围-脑室内出血相关因素分析

目的 探讨早产极低出生体质量儿(VLBWI)脑室周围-脑室内出血(PVH-IVH)相关影响因素.方法 回顾性分析新生儿重症监护室收治的VLBWI,根据颅脑B超检查结果,将其分为PVH-IVH组和非PVH-IVH组,分析分娩前、后临床因素在两组之间的差异,并进行PVH-IVH多因素Logistic回归分析.结果 共收集143例早产VLBWI,97例发生 PVH-IVH(67. 8％),其中 I 级 8 例(8. 2％)、II 级 65 例(67.0％)、Ⅲ级22例(22.7％)、Ⅳ级2例(2. 1％).单因素分析显示,PVH-IVH组中出生胎龄低于非PVH-IVH组,胎粪污染、窒息、肺泡表面活性物质使用、机械通气、呼吸窘迫综合征、呼吸暂停、新生儿坏死性小肠结肠炎(NEC)、贫血、败血症、低血糖等发生率高于非PVH-IVH组,差异均有统计学意义(P<0.05);多因素Logistic回归分析显示,窒息(OR =3. 432,95％ CI:1. 193～9. 874,P =0. 022),NEC(OR =7. 073, 95％ CI:1. 279～39. 125,P=0. 025)、贫血(OR=3.313,95％ CI: 1.273～8. 624,P =0.014)是早产 VLBWI 发生 PVH-IVH的独立危险因素(P<0.05).结论 早产VLBWI发生 PVH-IVH与窒息、NEC、贫血有关,应加强围生期管理,减少生后并发症的出现,可降低早产儿PVH-IVH的发生.

Analysis of related factors of periventricular intraventricular hemorrhage in premature very low birth weight infants

Objective To investigate the related influencing factors of periventricular intraventricular hemorrhage(PVH-IVH) in premature very low birth weight infants (VLBWI). Methods The clinical data of VLBWI in Anhui provincial children's hospital were retrospectively collected. According to the result of cranial ultrasound examination, they were divided into PVH-IVH group and non-PVH-IVH group, the difference of clinical factors between before and after delivery in two groups were analyzed, and Logistic regression was used to analyze the related clinical factors. Results A total of 143 cases of preterm VLBWI were collected and 97 (67. 8％) had PVH-IVH, 8(8. 2％) with grade I, 65(67. 0％) with grade II, 22(22.7％) with grade III and 2(2. 1％) cases with grade IV. Univariate analysis showed that the birth age in the PVH-IVH group was lower than that in the non-PVH-IVH group, and the incidence of meconium contamination, asphyxia, pulmonary surfactant use, mechanical ventilation, respiratory distress syndrome, apnea, neonatal necrotizing enterocolitis(NEC), anemia, septicemia and hypoglycemia were higher than those of non-PVH-IVH. There was significant difference between two groups (P＜0.05). Multivariate Logistic regression analysis showed that asphyxia (OR =3. 432, 95％CI: 1. 193～9. 874, P =0. 022), NEC(OR =7.073, 95％ CI: 1.279～39. 125, P =0.025), and anemia(OR =3. 313, 95％ CI: 1.273～8. 624, P=0. 014) were independent risk factors for PVH-IVH in preterm VLBWI (P＜ 0. 05). Conclusion PVH-IVH is associated with asphyxia, NEC, and anemia in preterm VLBWI. Perinatal management should be strengthened and prevent the appearance of complications so as to reduce the incidence of PVH-IVH in premature infants.