早产儿视网膜病的危险因素分析及随访调查

Analysis of risk factors of retinopathy of prematurity

研究早产儿视网膜病(retinopathy of prematurity,ROP)的发生率、高危因素、治疗与随访情况。方法对2005年7月-2007年12月温州医学院附属第一医院NICU收治的符合ROP筛查标准的早产儿,于生后2周开始由资深眼科医师开始行间接眼底镜检查眼底,并进行随访。结果434例早产儿中ROP的发生率为5.5%(24/434例),24例ROP中Ⅰ期19例,Ⅱ期3例,Ⅲ期2例。Ⅲ期阈值病变者行激光光凝治疗,全部患儿均恢复正常。对434例早产儿行单因素分析得出,胎龄、出生体重、住院时间、吸氧、吸氧浓度、吸氧时间、呼吸暂停、新生儿肺透明膜病(RDS)、肺表面活性剂(PS)的应用、机械通气、输血、光疗时间、感染与ROP的发生有相关性(P<0.05)。Logistic回归分析显示胎龄、出生体重、胎数、吸氧时间、光疗时间、代谢性酸中毒、母亲妊高症、颅内出血是影响ROP发生的主要因素。结论早产是ROP的根本原因,防治各种并发症、合理的氧疗是预防ROP的关键。建立完善有效的ROP筛查制度,早期发现、早期治疗ROP,可改善ROP的预后。

Objectives To explore the incidence, risk factors, treatment and follow-up of retinopathy of prematurity（ROP）. Methods 434 premature infants admitted to neonatal intensive care unit（NICU）of the First Affiliated Hospital of Wenzhou Medical College from July 2005 to December 2007 have undergone indirect funduscopic examinations two weeks after birth, and then they were followed-up. Results The incidence of ROP was 5.5% （24/434）. Among the 24 patients,19 were diagnosed with stage Ⅰ,3 with stage Ⅱ,2 with stage Ⅲ. The patients with stage Ⅲ threshold were treated by laser photocoagulation, and all recovered. Single factor analysis was done to find out the relationship among risk factors of ROP. The results showed that gestation age,birth weight,length of stay,oxygen inhalation,concentration of oxygen inhalation,time of oxygen inhalation,apnea,hyaline membrane disease（HMD）,application of pulmonary surfactant,mechanical ventilation, blood transfusion,times of blood transfusion,time of phototherapy and infections were significantly related to ROP（P 〈 0.05）. Logistic regression analysis showed that gestation age,birth weight,numbers of fetus,duration of oxygen inhalation,duration of phototherapy,metabolic acidosis,maternal hypertension during pregnancy intracranial hemorrhage（ICN）were associated with ROP. Conclusions Prevention of prematurity is fundamental to ROP prevention. Prevention of all kinds of complications and reasonable oxygen therapy are key points to ROP prevention. Establishing a sound and effective ROP screening system,early diagnosis and treatment can improve the prognosis of ROP.