婴幼儿脑室出血后脑积水的危险因素分析

Analysis of risk factors of hydrocephalus after intraventricular hemorrhage in infants

目的探讨婴幼儿脑室出血后脑积水(posthemorrhagic hydrocephalus,PHH)的相关因素。方法回顾性分析2013年6月至2022年1月郑州大学第三附属医院神经外科收治的112例脑室出血(intraventricular hemorrhage,IVH)患儿临床资料,通过随访IVH患儿是否发展为脑积水来探讨PHH的相关因素。将随访过程中出现脑积水者纳入PHH组,未出现脑积水纳入无脑室扩张(resolved ventricular dilation,RVD)组。采用单因素分析及多因素Logistic回归分析探讨IVH后发生脑积水的相关因素。结果112例中,55例(55/112,49%)发生PHH;58例(51.79%)行单纯保守对症治疗,28例(25%)行腰椎穿刺,26例(23.21%)行VPS治疗。5例(4.46%)死亡,其中2例死于肺功能不全,3例死于多器官功能衰竭;107例存活患儿中,随访期间出现3例(2.80%)癫痫,1例(0.93%)视力障碍,6例(5.61%)听力障碍,5例(4.67%)脑性瘫痪。多因素Logistic回归分析结果显示:出生时胎龄28~32周(OR=19.078,95%CI:2.408~151.140,P=0.005)、产前未使用类固醇(OR=20.642,95%CI:1.882~226.404,P=0.013)、脑室出血级别高(OR=94.193,95%CI:16.583~535.043,P<0.001)是PHH发生的独立危险因素。结论IVH患儿低胎龄,脑室出血级别高,产前未使用类固醇均与婴幼儿PHH存在关联。围术期应关注IVH患儿胎龄、产前使用类固醇情况及脑室出血级别,及时干预,避免其发展为PHH,从而改善患儿预后。

Objective To explore the related risk factors of posthemorrhagic hydrocephalus(PHH)after intraventricular hemorrhage(IVH)in infants.Methods From June 2013 to January 2022,retrospective analysis was conducted for clinical data of 112 hospitalized children.Exploring the related factors of PHH by following up on whether the patient has developed hydrocephalus after IVH.They were assigned into two groups of PHH(n=55)and resolved ventricular dilation(RVD,n=57).Univariate and multivariate Logistic regressions were utilized for examining the risk factors of hydrocephalus after IVH.Results And 55 cases(55/112,49%)developed PHH.58 cases(51.79%)received simple conservative symptomatic treatment;28 cases(25%)underwent lumbar puncture.Twenty-six patients(23.21%)received VPS treatment.The incidence of PHH was 49%(55/112).Among 112 children,5(4.46%)died from pulmonary insufficiency(n=2)and multiple organ failure(n=3).Among 107 survivors,there were epilepsy(n=3,2.80%),visual impairment(n=1,0.93%),hearing impairment(n=6,5.61%)had and cerebral palsy(n=5,4.67%)during follow-ups.The results of multivariate Logistic regression analysis showed;Gestational age at birth was 28 to 32 weeks(OR=19.078,95%CI:2.408-151.140,P=0.005)and prenatal steroids were not used(OR=20.642,95%CI:1.882-226.404,P=0.013)and high ventricular hemorrhage(OR=94.193,95%CI:16.583-535.043,P<0.001)were independent risk factor for PHH.Conclusions Low gestational age,prenatal steroids were not used,and high ventricular hemorrhage are all associated with PHH in infants and young children with IVH.During the perioperative period,attention should be paid to the gestational age,weight,prenatal steroid use,and level of intraventricular hemorrhage in IVH patients,and timely intervention should be taken to prevent their development into PHH and improve their prognosis.