摘要
目的调查6年来早产新生儿发生脑室周围白质软化(PVL)的危险因素。方法以2002年8月-2008年11月经头颅B超或MRI诊断为PVL的患儿为研究组,按1∶2数量配对抽取入院日期最接近,入院日龄、胎龄、出生体质量相近、诊断为早产儿脑室周围强回声(PVE)的早产儿(PVE组)和无相应神经系统检查异常发现的早产儿(正常对照组)为研究对象,对PVL危险因素进行分析。结果单因素分析显示,与正常对照组相比,PVL组和PVE组新生儿呼吸窘迫综合征(NRDS)(50%比12.5%,χ2=10.000,P=0.002;32.5%比12.5%,χ2=4.588,P=0.032)和肺部合并症(30.0%比5.0%,P=0.013;22.5%比5.0%,χ2=5.165,P=0.023)发生率较高;使用呼吸支持频率高(85.0%比27.5%,χ2=17.712,P<0.001;52.5%比27.5%,χ2=5.208,P=0.022);PVL组呼吸支持频率高于PVE组(85.0%比52.5%,χ2=6.065,P=0.014)。PVL组24h内最低PaCO2低于正常对照组[(33.5±7.5)mmHg比(42.0±9.8)mmHg,LSD=8.578,P=0.003],24h内最低pH值高于PVE组(7.326±0.129比7.254±0.092,LSD=0.072,P=0.008),颅内出血发生率较PVE组和正常对照组高(30%比5%,P=0.013;30%比2.5%,P=0.004)。多因素分析发现,围生期/出生早期感染、呼吸支持、24h内最低PaCO2和颅内出血是PVL发生的主要高危因素,其OR值(95%CI)分别为5.745(0.778,42.430)、9.370(2.168,40.504)、0.937(0.872,1.007)、1.826(1.083,3.077)。结论早产儿PVL致病因素复杂,围生期/出生早期感染、呼吸支持、24h内最低PaCO2和颅内出血是重要原因,有待进一步加强围产期保健,提高危重症患儿治疗水平,以减少PVL的发生。
Objective To investigate the risk factors of periventricular leukomalacia（PVL） in premature infants,and to promote care. Methods Data of the premature infants admitted in Peking University First Hospital between August 2002 and November 2008 were studied. Twenty premature infants diagnosed with PVL（diagnosed by ultrasound or MRI） were enrolled in the study. Forty premature infants with normal brain ultrasound（normal control group） or 40 premature infants diagnosed with periventricular echodensity（ PVE group） were studied as control. Admission time,age at admission,gestational age,and birth weight of two control groups were matched to the PVL infants. Risk factors of PVL were analyzed retrospectively. Results Univariate analysis showed that neonates with PVL and PVE suffered from neonatal respiratory distress syndrome（NRDS） more frequently（50% vs 12.5%,P = 0.002;32.5% vs 12.5%,P = 0.032,respectively） ,had more pulmonary complications（30.0% vs 5.0%,P = 0.013;22.5% vs 5.0%,P = 0.023） ,and needed more respiratory support（85.0% vs 27.5%,P 〈 0.001;52.5% vs 27.5% P = 0.022） than control group. PVL group was more likely to require respiratory support and higher pH than PVE group（85.0% vs 52.5%,P = 0.014;7.326 ± 0.129 vs 7.254 ± 0.092,P = 0.008） ,and lower PaCO2 within 1st 24 h than control group（（33.5 ± 7.5） mmHg vs（42.0 ± 9.8） mmHg,LSD = 8.578,P = 0.003） ） . The incidence of intraventricular hemorrhage（IVH） was highest in PVL group,the second in PVE group,the lowest in the normal premature group（30% vs 5%,P = 0.013;30% vs 2.5%,P = 0.004） . Multiple logistic regression analysis showed that perinatal infection,respiratory support,low 1st 24 h PaCO2 and IVH were high risk factors of PVL,OR（95% CI） were 5.745,9.370,0.937,and 1.826,respectively.Conclusions Many risk factors were associated with PVL,especially perinatal infection,respiratory support,low 1st 24 h PaCO2 and IVH. Much effort must be put forward to improve perinatal-neonatal health care and the standard of intensive care of neonates,to further decrease the incidence of PVL.
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2009年第9期837-841,共5页
Journal of Clinical Pediatrics
关键词
早产儿
脑室周围白质软化病
危险因素
premature infant
periventricular leukomalacia
risk factors
