早产儿颅内出血高危因素分析

Analysis of High Risk Factors in Premature Infants with Intracranial Hemorrhage

目的:研究早产儿颅内出血的主要危险因素。方法:颅内出血早产儿91例,对其性别、孕周、出生时体重、母亲年龄、胎盘异常、羊水情况、多胎、胎位情况、脐带情况、胎儿宫内窘迫、合并症、生产方式、Apgar评分、母亲孕期疾病、母亲原有疾病、孕期服药情况和小于胎龄儿等17个因素进行主成分分析,再将主成分分析中贡献率比较大的危险因素进行Logistic回归分析。抽取74例同期住院的无颅内出血的早产儿作为对照组。结果:主成分分析结果显示怀孕时间、出生体重、是否有宫内窘迫、以及1分钟Apgar评分、胎盘异常、脐带绕颈和小于胎龄儿等7个因素的贡献率分别为15.125%、11.934%、10.276%、9.885%、8.155%、6.545%、6.034%,累积贡献率达到67.953%。Logistic回归单因素分析结果显示:孕周和1分钟Apgar评分的OR值分别为3.462和5.917;95%可信区间分别为1.138-9.157和2.132-16.005;P值分别为0.002和0.000。说明二者为主要危险因素。结论:对孕周≤32周以及1分钟Apgar评分≤7分的早产儿应提高对其可能发生颅内出血的预见性和及早采取预防措施。

Objective： The aim of this study is to evaluate the high risk factors in premature infants with intraeranial hemorrhage. Methods： Ninety- one premature infants with intracranial hemorrhage were investigated. Seventy- four premature infants without intracranial hemorrhage as control were also included. Seventeen risk factors including gender, gestational age, birth weight, maternal age, placental causes, amniotic fluid abnormalities, multiple pregnancy, fetal presentation, umbilical cord abnormalities, fetal distress in uterus, complications, delivery presentation, Apgar scores, maternal disease resulting from pregnancy, maternal disease before pregnanal, taking drugs during pregnancy, and small for gestational age （SGA） were analyzed by using principal component analysis followed by logistic regression analysis. Results： The percentage of variances attributable to each factor such as gestational age, birth weight, fetal distress in uterus, Apgar scores, placental abnormalities, knotted umbilicalcordandSGAwere15.125%, 11.934%, 10.276%, 9.885%, 8.155%, 6.545% and6.034% respectively with principal component analysis. The cumulative percentage of them was 67.953%. Gestational age （Odds ratio （OR）, 4.462; 95% confidence interval （CI）, 1.138 - 9.1571 and Apgar scores at 1 minute （OR, 5.917; 95%CI, 2.132 - 16.0051 were found to be the main risk factors after these seven factors were analyzed by Logistic regression analysis. Conclusions： The risk of premature infants with low SGA （ ≤32 weeks） and 1 - minute Apgar score （≤7） to have intracranial hemorrhage should be predicted, and preventive management for it should be taken in advance by clinician.