微量元素和用氧时间对早产儿视网膜病发生的影响

【目的】探讨早产儿血微量元素及用氧对早产儿视网膜眼底病（ROP）发病的影响。【方法】28例早产儿（观察组）和18例正常足月儿（对照组），观察组均接受氧疗。出生后3～5d采用原子吸收分光光度计法检测血清微量元素（镁、铜、锰、硒）的水平。观察组早产儿根据ROP发生与否分为ROP组和非ROP组。记录早产儿用氧情况，包括用氧形式、时间及血气结果。【结果】观察组血清铜和硒的含量明显低于对照组（P〈0．01）。观察组内，10例发生ROP（35．71％），血清铜和硒水平在ROP组的降低幅度明显大于非ROP组（P〈O．05）。血清镁和锰在观察组和对照组无显著差别。ROP组婴儿用氧时间明显长于非ROP组，分别是（396．70士362．87）h和（163．72±122．68）h，两者差异显著（P〈0．01）。两组早产儿用氧形式无统计学差异；在氧疗期间动态监测血气分析，两组早产儿最大血氧分压值和血氧分压平均值均无统计学差异。【结论】ROP的发生涉及多种因素。早产儿体内微量元素铜、硒含量的不足可能减弱抗氧化酶的活性而增加ROP的发生。长时间用氧相对于较高的血氧浓度对引起早产儿ROP的发生有更大的危险性。

Effect of Trace Elements and the Duration of Oxygen Supply on the Incidence of Retinopathy of Prematurity

Objective]To explore the effect of serum trace elements in preterm infants and oxygen supply on the pathogenesis of retinopathy of prematurity（ROP）. Methods] The 28 premature infants （experiment group） and 18 full-term infants（control group） were enrolled into this study. The experiment group received oxygen therapy. Atomic absorption spectrophotometer method was used to detect serum trace elements inclu- ding Mg, Cu, Se and Mn at 3~5 days after birth. According to the incidence of ROP, the preterm infants in the experiment group were divided into ROP group and non-ROP group. The status of oxygen supply such as oxygen supply pattern, duration and blood gas of preterm infants were recorded. Results] Serum contents of Cu and Se in preterm infants were significantly lower than those in full-term infants（ P d0.01）. ROP oc- curred in 10 cases in the experiment group（35.71%）. Serum contents of Cu and Se in ROP group decreased more significantly than those in non-ROP group（ P d0.05）. There was no significant difference in serum con- tents of Mg and Mn between the experiment group and control group. The duration of oxygen supply in ROP group was obviously longer than that in non-ROP group（396.70＋362.87h vs 163.72＋ 122.68h）, and there was significant difference between two groups（ P ~0.01）. There was significant difference in the pattern of oxygen supply in preterm infants. The dynamic monitoring of blood gas during oxygen therapy showed that there was no significant difference in the maximum and average value of PaO2 between two groups. Conclu- sion]The occurrence of ROP is related to many factors. The deficiency of trace elements Cu and Se may in- crease the occurrence of ROP through reducing the activity of antioxidant enzyme. In addition, a long duration of oxygen supply makes greater contribution to the incidence of ROP than high arterial oxygen concentration.