极低出生体重儿脑室周围-脑室内出血高危因素分析

Risk factors for periventricular-intravenricular hemorrhage in very low birth weight infants

目的 探讨极低出生体重儿(VLBWI)脑室周围-脑室内出血(PVH-IVH)的高危因素。方法 回顾性对照分析2009年10月至2010年11月青岛大学医学院附属医院VLBWI117例病例,PVH-IVH39例为PVH-IVH组,按胎龄、出生体重1∶2配对的无PVH-IVH78例为对照组,对其相关因素采用SAS9.0软件进行配对条件Logistic回归分析。结果 130例VLBWI中发生PVH-IVH39例,发生率为30.00%。应用1∶2配对的条件Logistic回归分析示经阴分娩(OR=1461.699,CI7.216～296094.700,P<0.0001)、胎儿宫内窘迫(OR=95.172,CI2.213～4093.612,P=0.0006)、机械通气(OR=65.124,CI2.258～1878.432,P=0.0228)、动脉导管未闭(PDA)(OR=42.051,CI1.935～913.839,P=0.0283)、低钠血症(OR=33.415,CI0.936～1192.593,P=0.0475)、低钙血症(OR=25.175,CI1.328～477.243,P=0.0325)是VLBWI发生PVH-IVH的高危因素;产前使用激素(OR=0.061,CI0.004～0.884,P=0.0017)是避免患儿发生PVH-IVH的保护因素。结论 经阴分娩、胎儿宫内窘迫、机械通气、PDA及电解质紊乱是VLBWI发生PVH-IVH的高危因素,而产前使用激素可预防PVH-IVH的发生,因此PVH-IVH的发生是多种因素相互作用的复杂结果。在围生期工作中应当高度重视这些因素,以提高早产儿的生存质量。

Objective To investigate the high risk factors for periventricular-intraventricnlar hemorrhage （PVH-IVH） in very low birth weight infants （VLBWI）. Methods From October 2009 to November 2010 in Hospital of Medical College, Qingdao University, 39 VLBWI diagnosed with PVH-IVH were reviewed, and the control group consisted of 78 VLBWI without PVH-IVH, who were matched for gestational age and birth weight to each case of PVH-IVH. The data of 117 VLBWI were analyzed by 1 ： 2 conditional Logistic regression analysis of SAS 9.0. Results Totally 39 of 130 VLBWI were found to have PVH-IVH, indicating an incidence of 30.00%. The 1 ： 2 conditional Logistic regression analysis showed that vaginal delivery （OR = 1461.699, CI 7.216- 296094.700, P 〈 0.0001 ）, intrauteral embarrassment （OR = 95.172, CI 2.213 ~4093.612, P = 0.0006） , mechanical ventilation （OR = 65.124, CI 2.258-1878.432, P = 0.0228）, patent dnctus arteriosis （PDA） （OR = 42.051, CI 1.935 -913.839,P = 0.0283） ,hyponatremia（OR = 33.415, CI 0.936 ~ 1192.593, P = 0.0475 and hypocalcemia （OR = 25.175, CI 1.328 ~ 477.243, P = 0.0325）were the main risk factors for PVH-IVH in VLBWI, and antenatal steroid treatment （OR = 0.061, CI 0.004 ~ 0.884, P = 0.0017） was the protective factor. Conclusion Vaginal delivery, intrauteral embarrassment, mechanical ventilation, PDA and the electrolyte disturbances were the risk factors for PVH-IVH in VLBWI, and antenatal steroid treatment could protect the VLBWI from PVH-IVH, suggesting that PVH-IVH results from the reaction of many factors. These findings can be used to improve the quality of premature infants.