极低出生体重儿脑损伤临床及高危因素分析

目的 调查极低出生体重儿(very low birth weight infant,VLBWI)脑损伤发病情况并分析其高危因素,以探讨改善神经发育预后的方法.方法 回顾性分析2007年10月至2014年9月我院NICU收治的326例VLBWI脑损伤发生情况,分析脑损伤组(132例)与无脑损伤组(194例)在一般情况、高危围生因素、早产儿合并症和呼吸支持治疗方面的差异,并对相关危险因素进行Logistic回归分析.结果 326例VLBWI中,发生早产儿脑损伤132例,发生率40.49％;其中出血性脑损伤80例(24.54％,80/326),包括脑室周围-脑室内出血66例(20.25％,66/326)(Ⅰ～Ⅱ级41例、Ⅲ～Ⅳ级25例),非出血性脑损伤52例(15.95％,52/326),包括脑室周围白质软化46例(14.11％,46/326).脑损伤组及无脑损伤组的一般资料显示,除性别外,胎龄、胎数、出生体重等方面差异有无统计学意义(P＞0.05).进一步比较两组间高危围生因素、早产儿合并症及呼吸支持治疗共28个因素的分布,结果提示在窒息、绒毛膜羊膜炎、产前激素使用、新生儿呼吸窘迫综合征、低氧血症、呼吸暂停、肺出血、动脉导管未闭、低血压、酸中毒、低碳酸血症、贫血、高血糖、血小板减少、高频通气、宫外发育迟缓16个方面差异有统计学意义(P＜0.05),进一步二分类Logistic回归分析显示产前激素使用与脑损伤发生呈负相关,绒毛膜羊膜炎、酸中毒和动脉导管未闭与脑损伤发生呈正相关,早产儿脑损伤的危险分别增加了0.108、7.222、3.045和4.565倍.结论 VLBWI的实际病死率及脑损伤发生率仍较高.绒毛膜羊膜炎、动脉导管未闭和酸中毒与早产儿脑损伤的发生密切相关.产前激素可预防早产儿脑损伤的发生.在VLBWI的围生期管理中应高度重视这些影响因素,以降低早产儿脑损伤发生率.

Clinical and risk factors analysis of brain injury in very low birth weight infants

Objective To investigate the incidence of brain injury and analyze the risk factors in very low birth weight infants (VLBWI),in order to explore methods to improve neurodevelopmental outcome.Methods This was a retrospective study in which we reviewed the incidence of brain injury in 326 VLBWI who admitted to our NICU from October 2007 to September 2014.The differences of general characteristics,high-risk perinatal factors,complications of prematurity and respiratory support in brain injury group (n =132) and no brain injury group(n =194) were analyzed,and Logistic regression was used to analyze the related risk factors.Results In 326 VLBWI,premature brain injury was observed in 132 cases(incidence of 40.49％).Hemorrhagic brain injury was observed in 80 cases(incidence of 24.54％,80/326),in whom total 66 cases (20.25％,66/326) with periventricular-intraventricular hemorrhage (PVH-IVH),41 cases with PVH-IVH grade Ⅰ-Ⅱ,25 cases with PVH-IVH grade Ⅲ-ⅣV.Non-hemorrhagic brain injury was observed in 52 cases (incidence of 15.95 ％,52/326),in whom 46 cases with periventdcular leukomalacia (14.11％,46/326).There were no statistically significant differences in general characteristics except gender differences between the two groups.Further analysis of the 28 factors including high-risk perinatal factors,premature complications and respiratory support between the two groups,showed that there were significant differences in 16 factors including asphyxia,chorioamnionitis,antenatal steroid use,neonatal respiratory distress syndrome,hypoxemia,apnea,pulmonary hemorrhage,patent ductus artedosus,hypotension,acidosis,hypocapnia,anemia,hyperglycemia,thrombocytopenia,high frequency ventilation and extrautedne growth retardation.Further binary Logistic regression analysis showed that antenatal steroids use was negatively correlated with brain injury,chorioamnionitis,acidosis,and patent ductus arteriosus were positively correlated with brain damage,the relative risks of premature brain injury was 0.108,7.222,3.045 and 4.565 respectively.Conclusion The mortality rate and the incidence of brain injury in VLBWI are still high.Chorioamnionitis,acidosis and patent ductus arteriosus are closely associated with premature brain damage.Antenatal steroids can prevent premature brain injury.We should pay much attention to these risk factors in the perinatal management of VLBWI,in order to decrease the incidence of premature brain injury.