早产儿脑室周围白质软化危险因素分析

Risk Factors in the development of periventricular leucomalacia in preterm infants

目的探讨早产儿脑室周围白质软化(PVL)发生的危险因素。方法选取2007年1月至2008年6月在我院新生儿重症监护病房住院的早产低出生体重儿,生后1、3、7、14 d及28d行头颅B超检查,脑室周围有囊腔形成者为PVL组,无囊腔者为对照组。对23种产前及生后可能与PVL有关的因素进行分析,并将有意义的变量进行logistic回归。结果 PVL组21例,对照组48例。PVL组平均胎龄(30.6±2.0)周,明显低于对照组(31.9±2.1)周(P<0.05),生后6 h内第一次血气pH值亦明显低于对照组(7.20±0.08比7.25±0.06,P<0.05);颅内出血患儿PVL发生率70.0%(7/10)明显高于非颅内出血组23.7%(14/59)(P<0.05),机械通气患儿PVL发生率58.3%(7/12)亦明显高于非机械通气组24.6%(14/57)(P<0.05)。多因素Logistic回归分析显示,生后6 h内第一次血气pH值降低(OR=4.395,95%CI 0～0.537)和颅内出血(OR=4.741, 95%CI 1.188～26.644)是PVL的危险因素(P<0.05)。结论生后6 h内第一次血气pH值降低和颅内出血是发生PVL的主要危险因素,减少酸中毒和颅内出血对降低PVL的发生率很有意义。

Objective To investigate the high risk factors in the development of pereventricular leucomalacia （PVL） in preterm infants. Methods Sixty-nine premature infants admitted to our hospital＇s neonatal intensive care unit between January 2007 to June 2008 were studied. PVL were diagnosed with cystic formation on serial cranial sonography. Premature infants without cystic formation were kept as control group. Twenty-three perinatal factors were analyzed by Crosstabs Test or t Test with SPSS 13.0. Logistic regression analysis was used to identify the high risk factors associated with the development of PVL Results Twenty-one cases were diagnosed as PVL group, 48 cases without PVL were control group. The mean gestational age （30. 6 ±2. 0） w in PVL group were significant lower than control group （31.9 ± 2. 1 ） w （P 〈 0. 05）, the first pH value within six hours after life was also significant lower than control group （7.20±0.08 vs 7. 25±0.06, P 〈0.05）. The incidence of PVL in premature infants with intracranial hemorrhage （ICH） was significant higher than preteerm infants without ICH （70. 0% vs 23. 7%, P 〈 0. 05 ）, and meanwhile incidence of PVL in preterm infants with ventilator is also significant higher than preterm infants without ventilator （58.3% vs 24. 6% , P 〈 0. 05 ）. Multivariate Logistic regression revealed that the first low pH value within six hours after birth （ OR =4. 395, 95% CIO -0. 537） and ICH （ OR = 4. 741,95% CI 1. 188 - 26. 644） were high risk factors for PVL （ P 〈 0. 05 ）. Conclusion The first low pH value within six hours after birth and ICH were the major risk factors for PVL.