早产儿脑病相关危险因素回顾性分析

Retrospective Analysis of Risk Factors for Encephalopathy in Premature Infants

目的探讨早产儿脑病的发生情况,并分析其相关危险因素,以降低其发病率,改善神经发育预后。方法对2009年11月1日-2010年10月31日青岛大学医学院附属医院NICU收治的胎龄≤32周的186例早产儿行头颅MRI检查,分析早产儿脑病的发生率,根据头颅MRI表现分为颅内出血组和无颅内出血组、缺血性脑损伤组和无缺血性脑损伤组,头颅MRI未发现异常者设为对照组,详细统计临床资料,应用SPSS 17.0软件进行数据分析,比较2组基本情况、产科病理、生后并发症及治疗措施方面的差异;对相关因素进行Logistic回归分析,筛选出早产儿脑病的高危因素。结果 1.早产儿脑病发生率为36.0%(67/186例),出血性脑损伤发生率为29.0%(54/186例);缺血性脑损伤发生率23.1%(43/186例);缺血性脑损伤中局灶性损伤20例,弥散性损伤23例;67例患儿中同时表现出血及缺血性损伤的发生率16.1%(30/186例);43例缺血患儿中11例表现为神经元轴突损伤。2.脑病组与对照组出生胎龄及第1次MRI检查时间的差异均无统计学意义(Pa>0.05),出生体质量的差异有统计学意义(P<0.05)。3.Logistic回归分析:母孕期感染、产道分娩、脓毒症、机械通气是出血性脑损伤的独立危险因素,出生体质量为其保护因素;机械通气、脓毒症、低碳酸血症是缺血性脑损伤的独立危险因素,出生体质量、产前激素为其保护因素。结论早产儿脑病是多种因素相互作用的复杂结果,母孕期感染等宫内暴露因素、围生期缺氧及出生后感染均为早产儿脑病的危险因素。

Objective To explore the epidemiological rule and correlated risk factors of encephalopathy in premature infants and to reduce its morbidity and improve the developmental outcome. Methods The study was retrospectively performed on 186 preterm infants（≤32 weeks） from Nov.1,2009 to Oct.31,2010 at the Neonatal Intensive Care Unit of Affiliated Hospital Qingdao University Medical College.Detailed clinical data of all subjects were recorded.According to magnetic resonance imaging（MRI）,all subjects were divided into hemorrhagic brain injury group and no hemorrhagic brain injury group,ischemic brain injury group and no ischemic brain injury group;and no unusual performance subjects were kept as control group.Crosstabs test with SPSS 17.0 was applied to analyze the data,using χ2 or t-test. The diffe-rences of 2 groups in terms of basic situations,maternity pathological conditions,after-birth complications and treatment measures were compared,correlation factors were screened out by using Logistic regression analysis.Clinical data of the patients were analyzed to determine the incidence and the risk factors of brain damage. Results 1.Among 186 preterm infants,67 cases（36%） were detected with encephalopathy,which included 54 cases（29%） with hemorrhagic brain injury and 43 cases（23.1%） with ischemic brain injury.Among the 67 cases,there were 30 cases（16.1%） with hemorrhagic and ischemic brain injury;Among the 43 cases with ischemic brain injury,11 cases with neurons axonal injury were detected.2.There were no statistically significant ischemic differences in gestational age and the first time of MRI time between brain injury and control cases（Pa0.05）,and the birth weight differences were considered statistically significant（P0.05）.3.Logistic regression analysis： mother pregnancy infection,vaginal delivery,septicemia,mechanical ventilation were independent risk factors for hemorrhagic brain injury,while the birth weight was its protective factor.Mechanical ventilation,septicemia,low carbonated hematic disease were independent risk factors for ischemic cerebral injury,while the prenatal use of cortical hormone and birth weight were its protective factors. Conclusions Therefore premature infant brain injury is a complex outcome of multiple factor interaction.Intrauterine exposure including prenatal mothers suffered from infection,perinatal hypoxia and infection after birth are risk factors for encephalopathy in premature infants.