早产儿脑室周围-脑室内出血继发脑积水的高危因素

Risk factors for hydrocephalus after periventricular-intraventricular hemorrhages in premature infants

目的探讨早产儿脑室周围-脑室内出血（PVH—IVH）继发脑积水的高危因素，为早产儿PVH-IVH继发脑积水的防治提供依据。方法2007年6月至2012年6月入住NICU、出生3～7d床旁头颅B超检查结果提示存在PVH．IVH的早产儿214例，根据预后不同分为单纯PVH-IVH组（n=161）和PVH-IVH继发脑积水组（n=53），采用单因素分析和多因素Logistic回归分析调查PVH-IVH后继发性脑积水的高危因素。结果单因素分析显示，男童、胎龄〈28周、出生体质量〈1000g、重度窒息、PVH-IVHⅢ级或Ⅳ级、代谢性酸中毒、低钠血症、低血糖症或高血糖症等8个因素与早产儿PVH—IVH继发脑积水的发生相关（P均〈0．05）；多因素Logistic回归分析显示，男童（OR=3．317）、重度窒息（OR=13．838）、PVH-IVHⅢ级或Ⅳ级（OR=43．281）、低钠血症（OR=2．731）是早产儿PVH．IVH继发脑积水的独立危险因素（P均〈0．05）。结论男童、重度窒息、PVH．IVHⅢ级或Ⅳ级、低钠血症与早产儿PVH．IVH继发脑积水的发生密切相关，早产儿出现PVH—IVH后，应高度重视这些因素，以预防脑积水的发生。

Objective To study the risk factors for secondary hydrocephalus after periventricular-intraventricu- lar hemorrhage（PVH-IVH）in premature infants. Methods From Jun. 2007 to Jun. 2012,214 premature infants who were admitted to the Neonatal Intensive Care Unit after birth were enrolled and head ultrasonography showed PVH-IVH from 3 to 7 days after birth. They were classified into PVH-IVH alone group （n = 161 ） and secondary hydrocephalus af- ter PVH-IVH group （ n = 53 ） based on the different prognosis. Single factor and multivariate Logistic regression analysis were used to identify risk factors for secondary hydrocephalus after PVH-IVH. Results Single analysis indicated 8 fac- tors associated with hydrocephalus after PVH-IVH,including male, gestational age 〈 28 weeks, birth weight 〈 1000 g, severe asphyxia, PVH-IVH Ⅲ or Ⅳ, metabolic acidosis, hyponatremia, and hypoglycemia or hyperglycemia （all P 〈 0.05 ） ;multivariate Logistic regression analysis showed that male （ OR = 3.317 ）, severe asphyxia （ OR = 13. 838 ）, PVH-IVH Ⅲ oriv （ OR = 43.281 ）, and hyponatremia （ OR = 2.731 ） were independent risk factors for hydrocephalus af- ter PVH-IVH （ all P 〈 0. 05 ）. Conclusions Male, severe asphyxia, PVH-IVH HI or Ⅳ, and hyponatremia are closely related to hydrocephalus after PVH-IVH in preterm infants. After PVH-IVH, these clinical risk factors should be fol- lowed closely in the prevention of hydrocephalus.