广东省早产儿规范氧疗前后视网膜病变的变化

Changes of retinopathy of prematurity of Guangdong province before and after criterion oxygen-treatment

目的:了解广东省早产儿视网膜病(retinopathy of prematurity,ROP)筛查工作的开展情况和ROP的特点。方法:在广东省珠三角、粤东、粤北、粤西片区中各随机抽取新生儿科床位数≥50张,且最迟2005年始有眼科专业医师进行常规ROP筛查的2所三甲综合医院和2所二/三甲妇幼保健院,采用封闭式表格信函调查2002-01/2007-12在所选医院/保健院住院、出生胎龄≤36wk且出生体质量≤2000g且存活达2mo或以上的早产儿的临床及ROP筛查随访资料,然后电话核实;调查资料统计学分析采用u检验、χ2检验。结果:2004年以前未筛查早产儿占82.8%;2005年以后未筛查早产儿占24.9%,其中35～36wk未筛查早产儿占72.7%,29～32wk早产儿的筛查率93.6%,≤28wk的早产儿无漏筛病例。2002/2004年ROP筛查率较低,2005/2007年ROP筛查率显著提高,两时间段比较差异有非常显著性的统计学意义(P<0.01)。2004年以前多数医院(85.7%)使用直接眼底镜进行ROP筛查,2005年以后多数医院(71.4%)改用间接眼底镜进行ROP筛查。2004年以前ROP发生的真实情况无法了解。2005/2007年早产儿ROP发生率为6.2%,2005年以后出生体质量<1000g的早产儿ROP发生率为33.1%(105例),出生体质量1000～1499g10.8%(250例),出生体质量≥1500g的早产儿无ROP病例,≤28wk的早产儿ROP发生率为41.5%(56例),>28～32wk为9.8%(284例),>32～34wk为0.7%(15例),>34～36wk的早产儿无ROP发生。结论:规范氧疗后ROP筛查率明显提高,ROP发生率降低;《指南》[1]促进了ROP筛查工作的开展,筛查工具仍有待规范化。

AIM： To evaluate the retinopathy of prematurity（ROP） situations of Guangdong province before and after criterion oxygen-treatment. METHODS： In pearl river delta, west, east, and north of Guangdong, 2 three-level general hospitals and 2 two/ three level maternal and child healthcare hopitals with 50 or over neonate sickbeds and carrying out routinely ROP- screening at least from 2005 were randomly seleted, retrospectively investigating the data of inpatient from January 2002 to December 2007 with gestation, age ≤36 weeks and birthweight≤2000g who lived for 2 months or over in Guangdong province. The data was statistically analysised by u test and X^2 test. RESULTS： Patients with no ROP-screening consisted of 82.8% （3259/3934 cases） before 2004; and after 2005, 1 432 prematures had not been screened. 35-36 weeks prematres accounted for 72. 7% （1041 cases ）; ROP- screening rate of 29-32 weeks prematures was 93. 6%; none of prematures less or equal to 28 weeks were left out from ROP screening. Between 2002/2004, ROP screening rates of two kind hospitals had statistical difference （ P 〈 0.05） ; from 2005 to 2007, ROP screening rates of two kind hospitals had no statistical difference. Before 2004, most hospitals （82.8%） used direct ophthalmoscopy to screen ROP; after 2005, most hospitals （（71.4%） used indirect ophthalmoscopy to screen ROP. The actual ROP incidence wouldn＇t be evaluated before 2004; The ROP incidence of 2005/2007 was 6.2% ; ROP incidence of birthweight 〈 1 000g patients was 33. 1% （105 cases）, 1000-1499g 10.8% （250 cases）, i〉 1500g 0% （no cases）, ≤28 weeks 41. 5% （56 cases）, 〉 28-32 weeks 9.8% （284 cases）, 〉 32-34 weeks 0,7% （15 cases）, 〉34-36 weeks no ROP cases. CONCLUSION. ROP screening rate had been obviously increased after Criterion oxygen-treatment, and ROP incidence was lowered;The guides promote ROP screening; Screening tools still ought to be standardization.