早产儿视网膜病变筛查结果分析

Analysis on screening results of retinopathy of prematurity

目的探索适合成都及周边地区早产儿视网膜病变（retinopathy of prematurity，ROP）的筛查模式。方法回顾性调查分析研究。对2007年12月至2011年3月在四川省人民医院及成都市妇女儿童中心出生的332例体重2500g以下或孕周小于34周的早产儿，自生后4-6周或矫正胎龄32周开始筛查至周边视网膜血管化。结果332例早产儿中有41例发生了早产儿视网膜病变，占12．35％。其中严重的4例（7只眼）接受了激光治疗，1例（1只眼）接受视网膜冷凝联合巩膜环扎手术治疗，占1．20％。按照卫生部制定的筛查标准，仅259例受检儿符合标准，ROP检出率为14．29％，有4例ROP患儿漏诊。眼底正常组患儿出生孕周和体重均明显高于ROP组，两组间有吸氧史者所占比例及不同严重程度ROP组与未发生ROP组吸氧时间的差异有统计学意义。结论出生体重、胎龄、吸氧为早产儿视网膜病变发生的重要危险因素，婴儿出生的成熟度越低，早产儿视网膜病变尤其是严重的早产儿视网膜病变发病可能性越高。成都及周边地区ROP筛查标准应在卫生部制定的ROP筛查标准的基础上适当扩大范围。

Objective To analyze the present incidence of ROP （retinopathy of prematurity） in Sichuan Province People＇s Hospital and Chengdu Medical Center for Women and Children and to in- vestigate the appropriate mode for the screening of retinopathy of prematurity in Chengdu and sur- rounding area. Methods A total of 332 infants born between December 2007 and March 2011 with a birth weight of 2500g or less than 34 gestational weeks were studied. They were screened for ROP from 4-6 weeks of chronological age or 32 weeks of postmenstrual age until the retina was en- tirely vascularised. Results The incidence of ROP was 12.35%. Four severe cases required photocoag- ulation therapy or scleral buckling （1.20%）. If current national screening criteria had been followed, only 259 infants of the 332 cases would have been screened, and 4 cases of ROP wOuld have been missed. A younger gestational age at birth, lower birth weight, and longer duration of oxygen thera- py were correlated with the incidence of ROP. Conclusions Gestational age, birth weight and oxy- gen therapy remain the most important risk factors for ROP. The probability of ROP, particularly se- vere ROP, is highest in the most immature infants. More inclusive screening criteria utilized in Chengdu and its surrounding area than the current national standard result in diagnosing cases of ROP that otherwise will be missed.