高危新生儿眼底出血临床分析

Clinical analysis of retinal hemorrhages in high-risk infants

目的观察高危新生儿眼底出血的发生情况，探讨其相关危险因素。方法早产或有窒息史、其母有高危分娩史的860例出生后1～5d高危新生儿纳入研究。其中，经阴道分娩498例，剖宫产362例。经阴道分娩的498例新生儿中，顺产407例，产钳助产91例；产程正常298例，阴道产中滞产102例，急产98例。均散瞳后进行眼底检查，观察眼底出血发生情况，并将出血程度分为Ⅰ、Ⅱ、Ⅲ3种。根据Apgar评分观察眼底出血者的窒息发生情况及窒息程度。分析跟底出血与分娩方式、产程的关系，眼底出血程度与窒息程度的关系。结果860例高危新生儿中，眼底出血202例，占23．5％。202例眼底出血者中，Ⅰ度眼底出血75例，占37．1％；Ⅱ度眼底出血75例，占37．1％；Ⅲ度眼底出血52例，占25．8％。202例眼底出血者中，曾发生窒息172例，占85．1％。172例曾发生窒息者中，轻度窒息119例，占69．2％；重度窒息53例，占30．8％。轻重度窒息高危新生儿发生眼底出血的程度比较，差异有统计学意义（x2=34．61，P〈O．01）。经阴道分娩者眼底出血的发生率明显高于剖宫产者，差异有统计学意义（x2=30．73，P〈o．01）。顺产者眼底出血的发生率明显低于产钳助产者，差异有统计学意义（x2=62．78，P〈0．01）。阴道产中滞产、急产者眼底出血的发生率明显高于产程正常者，差异均有统计学意义（x2=45．86、71．51，P〈0．01）。窒息、分娩方式、急产、滞产均是眼底出血的危险因素（r=7．46、4．87、15．03、6．47，P〈O．01）。结论高危新生儿眼底出血的发生率为23．5％。窒息、分娩方式、急产、滞产是导致眼底出血的可能危险因素。

Objective To investigate the related factors of the retinal hemorrhage in high-risk infants （HRI）. Methods Eight hundred and sixty HRI with histories of high-risk pregnancy and/or neonatal asphyxia after 1 - 5 days of birth were enrolled in this study. In 860 cases of HRI, 498 infants were vaginal delivery and 362 infants were delivered through cesarean sections. Among 498 vaginal delivered infants, 407 infants were eutocia and 91 infants were with labor, 102 infants experienced prolonged labor, forceps delivery; 298 infants were born following normal and 98 infants were urgent birth. The retinal hemorrhages were observed and conditions were graded into three degrees of Ⅰ、Ⅱ, and Ⅲ. Conditions of neonatal asphyxia were evaluated based on criteria of Apgar score. The incidence of retinal hemorrhage in the different types of deliveries and labor processes were compared, and the relationship between degree of retinal hemorrhage and grade of neonatal asphyxia were analyzed. Results In 860 cases of HRI, retinal hemorrhages were found in 202 infants （23.5%）. Within these 202 infants, 75 infants （37.1%） were Ⅰ degree retinal hemorrhage, 75 infants （37.1%） were Ⅱ degree retinal hemorrhage, and 52 infants （25.8 % ） were Ⅲ degree retinal hemorrhage. In these 202 infants of retinal hemorrhage, 172 infants （85.1%） had histories of asphyxia; 119 infants （69.2%） were graded as mild asphyxia-risk, and 53 infants （30.8%） were graded as severe asphyxia-risk. There was a statistical difference of the degree of the retinal hemorrhage between the mild and severe asphyxia-risk infants （X2 = 34.61, P〈0.01）. The incidence of retina], hemorrhage after vaginal delivery was higher than cesarean section delivery with significant statistical difference （ x2 = 30.73, P 〈 0.01）. The incidence of retinal hemorrhage after forceps delivery was significantly higher than eutocia with statistical difference （x2 = 62.78, P 〈 0.01）. Both prolonged and urgent childbirth had statistically significant higher incidences of retinal hemorrhage compared to normal labor in the process of vaginal delivery （x2=45.86, 71.51; P〈0.01）. Asphyxia, types of delivery,prolonged and urgent labors were risk lactors of retinal hemorrhage for HRI （r=7.46, 4.87, 15.03, 6.47% P〈 0.01）. Conclusions The incidence of retinal hemorrhage in high-risk infant was 23.5%. And, asphyxia, types of delivery, prolonged and urgent labors may play roles of risk factor in retinal hemorrhage of HRI.