早产儿颅内出血的危险因素分析及干预

Analysis of risk factor and intervention of intracranial hemorrhage in the premature infants

目的探讨引起早产儿颅内出血的危险因素,寻求对颅内出血的有效干预措施。方法回顾性分析2009年1月至2013年12月本院新生儿科收治的早产儿的临床资料,对发生颅内出血和未发生颅内出血的病例进行20个相关因素的单因素分析,对部分影响颅内出血的因素进行Logistic回归分析。结果 1 726例进入项目组的早产儿中,共有264例早产儿出现颅内出血。Logistic回归分析结果表明,建立新生儿转运网络、开展综合主动转运模式是早产儿颅内出血的保护因素;本研究发现是否基层医院转运成为独立存在的危险因素。2009年1月至2011年12月收治的714例早产儿中共有142例发生颅内出血,其中有88例为348例基层医院中转运,颅内出血的发生率为25.29%,与本院转运的366例早产儿颅内出血的发生率(14.75%)比较,差异有统计学意义(P<0.05)。本院于2012年1月开始建立完善新生儿转运网络,实施综合主动转运模式后,2012年1月至2013年12月收治的1 012例早产儿中共有122例发生颅内出血,其中有75例为490例基层医院中转运,颅内出血的发生率为15.31%,与本院转运的522例早产儿颅内出血的发生率(9.00%)比较,差异有统计学意义(P<0.05)。建立新生儿转运网络,开展综合主动转运模式前、后基层医院转运早产儿中颅内出血发生率比较,差异有统计学意义(P<0.01)。结论通过建立完善的区域性新生儿三级网络转运系统,采取综合主动型转运模式,可有效降低区域内早产儿颅内出血的发生率。

Objective To explore the risk factors and seek effective intervention of intracranial hemorrhage in the premature in fants. Methods Clinical data of the premature infants in our hospital from January 2009 to December 2013 was retrospectively analysed and single factor analysis of 20 relevant factors was done for cases with intracerebral haemorrhage and without intracerebral haemorrhage. Logistic regression analysis were done for some influence factors of intracranial hemorrhage. Results 1 726 cases of premature babies were included in the study, including 264 cases of intracranial hemorrhage. Logistic regression analysis results shown that the neonatal transport network and integrated active transport models are protective factors of intracranial hemorrhage in the premature infant. We found that basic-level hospital transport was an independent risk factor. Between January 2009 and De- cember 2011,142 of 714 premature infants were intracranial hemorrhage,including 88 cases from 348 patients transported from bas- ic-level hospital, the incidence of intracranial hemorrhage was 25.29 %, and compared with the incidence of intracranial hemorrhage （14.75 % ） of our hospital, the difference was statistically significant（P〈00.05）. From January 2012, we established perfect neonatal transport network and implementation of comprehensive active transport model. 122 of 1 012 premature infants were intracranial hemorrhage, including 75 cases of 490 patients from basic-level hospitals. The incidence was statistically significant different compared with the incidence of intracranial hemorrhage（9.00%） transported from our hospital（P〈0.05）. The incidence of intracranial hemorrhage in the premature infants transported from basic-level hospitals were statistically different before and after neonatal transport network and comprehensive active transport model was established（P〈0.01）. Conclusion It will effectively reduce the incidence of intracranial hemorrhage in the premature infant by establishing the perfect regional neonatal three-level network trans port system and comprehensive active transport models.