极低出生体质量儿脑损伤及高危因素分析

Risk factors of brain injury in very low birth weight infants

目的调查极低出生体质量儿脑损伤发病情况,分析其高危因素,以降低发病率,改善神经发育预后。方法回顾性分析181例极低出生体质量儿脑损伤发生情况,分析脑损伤组与无损伤组在基本情况、产科病理症、干预措施、合并症方面的差异,并对相关危险因素行Logistic回归分析。结果181例极低出生体质量儿中检出脑损伤78例,发生率43.09%。其中,脑室周围-脑室内出血(PVH-IVH)67例(Ⅰ级43例,Ⅱ级12例,Ⅲ级10例,Ⅳ级2例),发生率37.01%;脑室周围白质软化(PVL)12例,发生率6.63%,其中1例合并Ⅲ级IVH。胎龄越低,脑损伤发生率越高;脑损伤组与无损伤组在性别、胎数、出生体质量、分娩方式、宫内窘迫、胎膜早破、母亲妊高征、胎盘早剥、宫内发育迟缓(IUGR)方面差异均无统计学意义(P>0.05)。在治疗措施方面,除氨茶碱两组无差异外,应用肺表面活性物质(PS)、经鼻持续正压通气(nCPAP)、常频通气、高频通气治疗在脑损伤发生率方面差异均有统计学意义(P<0.05)。在合并症方面,两组在窒息、新生儿呼吸窘迫综合征(NRDS)、高碳酸血症、代谢性酸中毒、高血糖、贫血、动脉导管未闭(PDA)发生率差异有统计学意义(P<0.05),在低血糖、败血症、血小板减少、呼吸暂停、肺出血、高胆红素血症差异无统计学意义(P>0.05)。Logistic回归分析显示NRDS、PDA、高频震荡通气是脑损伤最重要的高危因素。结论极低出生体质量儿是脑损伤高危人群。应用PS、nCPAP、常频通气、高频通气以及窒息、NRDS、高碳酸血症、代谢性酸中毒、高血糖、贫血、PDA与脑损伤发生相关联,其中NRDS、PDA、高频震荡通气是重要高危因素。

Objective To investigate the incidence and high risk factors of brain injury in very low birth weight infants （ VLBWI） ,to reduce the morbidity of brain injury,and improve the developmental outcome of VLBWI.Methods Data of 181 VLBWI admitted in the neonatal intensive care unit （ NICU） between October 2008 and September 2009 were retrospectively analyzed.The difference in basic information,maternity diseases,treatment and complication were analyzed between two groups （ brain injury group and normal newborn group） ,and Logistic regression analysis was adopted to analyze the risk factors for brain injury.Results Seventy-eight of the 181 neonates （43.09% ） were found to have brain injury,including 67 neonates （37.01% ） with periventricular / intraventricular hemorrhage （43 with intraventricular hemorrhage （IVH） gradeⅠ,12 with IVH grade Ⅱ,10 with IVH grade Ⅲ,and 2 with IVH grade Ⅳ ） and 12 neonates （ 6.63% ,one complicated with IVH grade Ⅲ ） with periventricular leukomalacia.The younger the gestational age,the higher the brain injury rate was observed.Concerning the brain injury rate,there were no differences in gender,single birth / plural births,birth weight,the mode of delivery,fetal distress,premature rupture of membrane,hypertension during pregnancy,placenta abruption,and intrauterine growth restriction （IUGR） between these two groups （P 〉0.05）.The difference in therapeutic measures such as pulmonary surfactant therapy,nasal continuous positive airway pressure （ nCPAP） ,conventional mechanical ventilation,and high-frequency oscillatory ventilation was significant （P〈0.05）,except aminophylline therapy （P〉0.05）.As to the complication,there were significant differences in the incidences of asphyxia,neonatal respiratory distress syndrome （ NRDS） ,hypercapnia,metabolic acidosis,hyperglycemia,anemia,and personal digital assistant （ PDA） （ P〈0.05） .However,there was no difference in the incidences of hypoglycemia,sepsis,thrombocytopenia,apnea,pulmonary hemorrhage,and hyperbilirubinemia between these two groups （ P 0.05） .Further Logistic regression analysis showed that NRDS,high-frequency oscillatory ventilation,and PDA were the main risk factors for brain injury in VLBWI.Conclusions VLBWI is the high-risk population of brain injury.Pulmonary surfactant therapy,nCPAP,conventional mechanical ventilation,high-frequency oscillatory ventilation,asphyxia,NRDS,hypercapnia,metabolic acidosis,hyperglycemia,anemia,and PDA were confirmed to be the high-risk factors for brain injury in VLBWI.And,NRDS,high-frequency oscillatory ventilation and PDA were main risk factors.