产前单疗程应用地塞米松对早产儿近远期预后的影响

目的 分析产前单疗程应用地塞米松对早产儿生后近远期影响,为改善早产儿预后提供科学依据。方法 回顾性分析2011年1-12月在盐城市妇幼保健院住院的289例早产儿资料。根据产前是否使用地塞米松分为干预组128例、对照组161例。按胎龄(GA)分成3个亚组:GA＜30周、30~33⁺⁶周和＞34周。对研究对象组一般资料及随访资料进行比较。结果 ＜30周:干预组点状脑白质损伤和弥漫性脑白质损伤(PWMD+DWMD)、脑室周围白质软化(PVL)、脑室周围-脑室内出血(PIVH-IVH)发生率,3、6岁时个人社交行为评分显著低于对照组(χ²=4.493、4.493、4.305,t =2.454、5.832,P＜0.05);1、2、3、6岁时大运动行为评分、精细动作行为评分显著高于对照组(t=3.599、4.231、4.626、8.552、9.171、6.742,P＜0.05)。30~33⁺⁶周:干预组PVL、PIVH-IVH发生率,3、6岁时个人社交行为评分均显著低于对照组(χ²=4.182、3.852,t=3.431、2.867,P＜0.05);1、2、3、6岁的大运动行为评分、精细动作行为评分显著高于对照组(t=2.346、2.975、6.446、5.392、2.541、4.683、1.871、6.043,P＜0.05)。＞34周:干预组2、3、6岁时大运动行为评分及精细动作行为评分显著高于对照组(t=2.236、3.184、6.130、2.569、5.506、5.131,P＜0.05),3、6岁个人社交行为评分显著低于对照组(t=2.473、2.315,P＜0.05)。结论 产前单疗程应用地塞米松对小胎龄早产儿脑损伤有一定保护作用,对早产儿远期运动行为有积极影响,但对早产儿远期个人社交行为有不良影响。

Effect of prenatal use of dexamethasone on short-term and long-term prognosis of premature infants

Objective To investigate effect of prenatal use of dexamethasone on short-term and long-term prognosis of premature infants,so as to provide scientific reference for improving prognosis of preterm infants. Methods A total of 289 premature infants in Yancheng Maternal and Child Health Care Hospital from January to December in 2011 were analyzed retrospectively.All participants were divided into intervention group (n=128) and control group (n=161) according to whether dexamethasone was suitable for prenatal treatment.According to different gestational age (GA),the participants were further divided into three subgroups:GA＜30 weeks,30-33⁺⁶ weeks and ＞34 weeks.General data and follow-up data of the different groups were compared. Results In children with GA under 30 weeks,the incidence of PWMD+DWMD,PVL,PIVH-IVH and social interaction score at the age of 3 and 6 years old in intervention group were significantly lower than those in control group(χ²=4.493,4.493,4.305,t=2.454,5.832,P＜0.05).And the scores of gross motor behavior and fine motor behavior at the age of 1,2,3,6 years old in intervention group were significantly higher than those in control group(t=3.599,4.231,4.626,8.552,9.171,6.742,P＜0.05).In children with GA 30-33⁺⁶ weeks,the incidence of PVL and PIVH-IVH,and social interaction score at the age of 3 and 6 years old in intervention group were significantly lower than those in control group(χ²=4.182,3.852, t=3.431,2.867,P＜0.05).And the scores of gross motor behavior and fine motor behavior at the age of 1,2,3,6 years old in intervention group were significantly higher than those in control group(t=2.346,2.975,6.446,5.392,2.541,4.683,1.871,6.043,P＜0.05).In children with gestational age over 34 weeks,the scores of gross motor behavior and fine motor behavior at the age of 2,3,6 years old in intervention group were significantly higher than those in control group(t=2.236,3.184,6.130,2.569,5.506,5.131,P＜0.05),while the scores of social interaction at the age of 3 and 6 years old were significantly lowerer than those in control group (t=2.473,2.315,P＜0.05). Conclusion Prenatal application of dexamethasone is of certain protective effect on brain injury of premature infants with small gestational age,and has positive effect on long-term motor and behavior development of premature infants.However,its negative effect on long-term personal social behavior of premature infants is supposed to be considered.