摘要
目的探讨早产儿脑损伤的患病率和危险因素,为预防或降低早产儿脑损伤提供依据。方法对2005年1月-2006年12月美国圣路易斯华盛顿大学儿童医院NICU收治的胎龄小于37周的早产儿的临床资料进行回顾性分析,按胎龄分组,计算脑损伤的患病率,采用多因素Logistic回归模型确立危险因素。结果本组早产儿总的脑室内出血(IVH)和脑室周围白质软化(PVL)的患病率分别为17.7%和4.9%,而存活病例的患病率分别为14.4%和4.5%。按胎龄分组,IVH和PVL的患病率分别为:23～<25周龄组48.1%和14.8%、25～<28周龄组35.2%和11.2%、28～<33周龄组13.8%和3.1%、33～<37周龄组2.8%和1.7%。坏死性小肠结肠炎、PDA、机械通气(MV)是IVH的独立危险因素,而胎龄、5minApgar评分为保护因素(负相关);IVH、MV、母亲产前或产时感染是PVL的危险因素,而出生体质量和女性为保护因素。同时IVH是导致早产儿死亡的危险因素。结论胎龄越小,脑损伤的患病率越高;围生期感染、窒息缺氧以及影响脑血流的因素如PDA和MV等与早产儿脑损伤的发生密切相关。
Objective To explore the incidence and risk factors of brain injury in preterm infants and provide basic data for prevention of brain injury and improvement of outcome in preterm infants.Methods Data were collected retrospectively among neonates with gestational age of 37 weeks,who were admitted to NICU in St.Louis Children＇s Hospital in Washington University School of Medicine from Jan.2005 to Dec.2006.Intraventricular haemorrhage（IVH）and periventricular leukomalacia（PVL）rates were calculated by gestational age.Binary Logistic regression was adopted to identify risk factors associated with brain injury in preterm infants.Results The incidence of IVH and PVL in total preterm population was 17.7% and 4.9%,respectively,while 14.4% and 4.5% in survival preterm infants,48.1% and 14.8% in group at gestational age of 23 to less 25 weeks,35.2% and 11.2% at 25 to less 28 weeks,13.8% and 3.1% at 28 to less 33 weeks,2.8% and 1.7% at 33 to less 37 weeks.Neonatal necrotizing enterocolitis,patent ductus arterious（PDA）,and mechanical ventilation（MV）were risk factors in IVH development,while larger gestational age and higher 5-min Apgar scores were protective factors.IVH,MV and maternal perinatal infection were risk factors in PVL,birth weight and female were protective factors.IVH was associated with increased mortality in preterm infants.Conclusions The incidence of brain injury is negatively related to gestational age.Perinatal infection,hypoxia,and the factors influencing cerebral blood dynamics such as PDA and mechanical ventilation are all associated with increased risk of brain injury in premature infants.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2011年第2期128-130,共3页
Journal of Applied Clinical Pediatrics
关键词
脑损伤
高危因素
患病率
婴儿
早产
brain injury
risk factor
incidence
preterm infant
