以磁共振成像诊断早产儿脑损伤相关危险因素的回顾性分析

目的探讨以MRI诊断的早产儿脑损伤的相关危险因素。方法回顾性分析中国医科大学盛京医院2年中早产儿脑损伤相关危险因素,以MRI（T1WI-T2WI）和弥散加权成像诊断早产儿脑损伤,详细统计临床资料,进行单因素分析,对单因素分析有统计学意义的因素行早产儿脑损伤主要危险因素的Logistic回归分析。结果358例早产儿中,无脑损伤177例,有脑损伤181例,其中缺血性脑损伤占70.7%（128/181）;单纯出血性脑损伤占53.0%（96/181）;缺血伴出血性脑损伤占23.7%（43/181）。对21种危险因素进行分析。单因素分析：急产、双胎妊娠、母孕期感染、循环障碍、产道分娩、代谢性酸中毒、低钠血症、低钙血症与早产儿出血性脑损伤有统计学意义;母孕期感染、母孕期糖尿病、产前使用硫酸镁、复苏抢救史、循环障碍、产道分娩、代谢性酸中毒、低钠血症、低钙血症与早产儿缺血性脑损伤有统计学意义。Logistic分析示：母孕期感染（OR=4.738,95%CI：1.201～18.685,P〈0.05）、产道分娩（OR=9.191,95%CI：4.699～17.979,P〈0.05）、低钠血症（OR=3.244,95%CI：1.173～8.969,P〈0.05）和低钙血症（OR=3.162,95%CI：1.325～7.545,P〈0.05）是早产儿出血性脑损伤的危险因素;母孕期糖尿病（OR=5.211,95%CI：1.272～21.341,P〈0.05）、产道分娩（OR=3.078,95%CI：1.824～5.194,P〈0.05）、低钠血症（OR=3.331,95%CI：1.506～7.366,P〈0.05）和低钙血症（OR=4.713,95%CI：2.412～9.209,P〈0.05）是早产儿缺血性脑损伤的危险因素,产前使用硫酸镁（OR=0.375,95%CI：0.183～0.766,P〈0.05）是其保护因素。结论母孕期感染、母孕期糖尿病等宫内暴露因素,分娩过程及出生后内环境紊乱均为早产儿脑损伤的危险因素,因此早产儿脑损伤是多种因素相互作用的复杂结果。在围生期的诊断治疗工作中应当尽量避免这些因素,减少神经系统并发症及降低其严重程度。

The epidemiologic study of premature infant brain injury diagnosed with magnetic resonance imaging

Objective To explore the epidemiological rule and correlated risk factors of premature infant with brain injury,on the basis of MRI.Methods The Study was prospectively performed on 358 preterm infants from January 2005 to January 2007 at the neonatal intensive care unit of the Shengjing Hospital of China Medical University.Detailed clinical data of all subjects were recorded,including：gender,gestation age,birth weight,and the following risk factors：precipitate labor,pregnancy-induced hypertension,fetal distress,twin,prenatal infection,placental abraption,placenta praevia,gestional diabetes mellitus,prenatal steroids recipitate,magnesium sulfate,resuscitation,circutatory disorder,vaginal delivery,infection,mechanical ventilation,blood gas analysis（metabolic acidosis,hyperkalemia,hyponatremia,hypocalcemia）.Conventional MRI and diffusion-weighted imaging（DWI） were performed in 358 preterm infants using 3 Tesla MR scanner.The infants were sedated for imaging with chloral hydrate（50 mg·kg-1）.Seriously ill intubated newborns were monitored by clinician during scanning and hand-ventilated,and pulse oximetry and electrocardiography were monitored throughout the procedure.All MRI scans were assessed by two radiologists,blinded to neonatal clinical data.Subjects with brain injury were classified into two different groups according to MRI：hemorrhagic brain injury and ischemic brain injury.Statistical analyses were performed using SPSS for Windows（ver.11.5）.All data were described as mean±standard deviation.Student＇s t test was used to evaluate the difference in numerical variables.The significance of the difference between premature infants with brain injury and control cases was tested using the Chi-square test.A logistic regression analysis was performed on factors which found to be significant in univariate analysis.A probability value of P〈0.05 was considered statistically significant.Results The number of premature infants with hemorrhagic brain injury was 128 cases（70.7%）;premature infa