新生儿脑梗死危险因素的系统评价

Systematic evaluation of risk factors of cerebral infarction in newborns

目的利用系统评价的方法探讨导致新生儿脑梗死的危险因素。方法通过检索中国知网、维普、万方、PubMed、0VID、Springer、Medline、ScienceDirectOnSite、Besco及MDConsult等数据库，收集1997年至2011年关于新生儿脑梗死危险因素的病例对照研究文献、病例报道文献及病例总结文献，按纳入和剔除标准进行筛选。采用随机效应模型或固定效应模型，通过ReviewManager5．0软件对病例对照文献进行荟萃分析。对病例报道及病例总结文献，分析新生儿脑梗死患儿中各危险因素的构成比。结果共检索269篇相关文献，符合纳人标准的文献共36篇，均为英文。其中病例对照文献3篇，病例总结文献17篇，病例报道文献16篇。病例对照文献累计病例80例，对照228例。各因素合并OR值（95％CI）分别为：胎动减少7．10（2．92～17．24）；胎心异常4．45（2．54～7．80）；胎吸2．99（1．23～7．25）；出生需要复苏3．14（1．17～8．46）；破膜时间长2．40（0．62～9．29）；刮宫产2．64（1．44～4．82）；子痫前期3．05（1．44～6．43）；母亲有不孕史1．25（0．18～8．67）；初产1．79（0．51～6．36）；催产素催产2．05（0．99～4．25）；胎儿生长受限0．99（0．47～2．11）；羊水粪染2．08（0．94～4．58）；不良产史0．85（0．43～1．68）；臀位0．38（0．10～1．46）。荟萃分析结果显示，胎动减少、胎心异常、胎吸、出生需要复苏、剖宫产、子痫前期是新生儿脑梗死的高危因素。病例总结文献17篇，共530例，其中异常分娩、胎儿窘迫、高凝状态在危险因素中所占比例较大，分别为31.70％、21．13％及20．19％。病例报道文献16篇，共25例，其中高凝状态所占比例较大，为32．00％。结论围产期缺氧、异常分娩、子痫前期、高凝状态可能是新生儿脑梗死的高危因素。

Objective To explore risk factors of cerebral infarction in newborns by systematic reviews. Methods Case-control studies and case reports on risk factors of cerebral infarction in newborns from January 1997 to December 2011 were collected from database of CNKI, CQVIP, Wanfang Database, PubMed, OVID, Springer, Medline, Science Direct On Site, Beseo and MD Consult. Meta analysis was performed on case-control studies with fixed or random effect model by Review Manager 5.0. Constitution ratio of risk factors of cerebral infarction in newborns in case reports was investigated. Results Two hundred and sixty-nine articles were found and among which, 36 articles in English were selected for this study. Three case-control studies were found and adopted for meta analysis. Cumulative number of patients and control cases were 80 and 228, respectively. The pooled OR and 95 ~CI of selected factors were as follows： decreased fetal movement F7.10 （2.92-17.24）], abnormal fetal heart rate [4.45 （2.54-7.80）], vacuum delivery {-2.99 （1.23- 7.25）], resuscitation at birth [（3.14 （1.17-8.46）], premature rupture of membranes [2.40 （0.62- 9.29）], cesarean section [2.64 （1.44-4.82）], preeclampsia [3.05 （1.44-6.43）], history of infertility [-1.25 （0.18-8.67）], primiparous [1.79 （0.51-6.36）], oxytocin used [2.05 （0.99- 4.25）], fetal growth restriction [0.99 （0.47-2.11）], meconium stained amniotic fluid [2.08 （0.94- 4, 58）], adverse pregnancy history [-0.85 （0.43-1.68）] and breech presentation [0.38 （0.10-1.46）]. Meta analysis showed that decreased fetal movement, abnormal fetal heart rate, vacuum extraction,resuscitation at birth, cesarean section and preeclampsia were risk factors of neonatal cerebral infarction. Decreased fetal movement, abnormal fetal heart rate and resuscitation at birth suggested that newborns suffered from perinatal hypoxia, vacuum extraction, cesarean section suggested abnormal delivery. It suggested that perinatal hypoxia and abnormal delivery were high risk factors of neonatal cerebral infarction. Among those factors,, proportion of abnormal labor, fetal distress and hypercoagulabe state was 31.70%, 21.13% and 20. 19%respectively： Conclusions Abnormal birth, hypoxia, preeclampsia and hypercoagulation state might relate to neonatal cerebral infarction.