早产儿脑室周围-脑室内出血的高危因素和保护因素

Risk and protective factors of periventricular-intraventricular hemorrhage in preterm infants

目的回顾性研究早产儿脑室周围-脑室内出血（PV-IVH）的高危因素和保护因素。方法采用1：1病例对照研究方法,收集2012年1月至2014年10月PV-IVH早产儿及对照组的产前和产后资料,通过单因素分析筛选,再经多因素条件logistic回归分析PV-IVH发生的高危因素和保护因素。结果共132例PV-IVH早产儿,6例未匹配到对照病例,最后共126对纳入分析;两组间胎龄、出生体质量的差异无统计学意义（P均〉0.05）。多因素条件logistic回归分析发现,首次血气分析BE值〈-5 mmol/L（OR=1.986,95.0%CI：1.039～3.796）、机械通气（OR=2.913,95%CI：1.390～6.101）、生后第2周体质量增长≤10 g/d（OR=2.303,95%CI：1.164～4.558）为PV-IVH的高危因素,而既往怀孕≥1次（OR=0.426,95%CI：0.229～0.792）为PV-IVH的保护因素。结论首次血气分析BE值〈-5 mmol/L、机械通气、生后第2周体质量增长≤10 g/d为早产儿PV-IVH发生的高危因素,需加强对早产儿PV-IVH发生高危因素的认识,及时给予正确处理。

Objective To identify risk and protective factors of the periventricular-intraventricular hemorrhage（PV-IVH） in preterm infants. Methods By 1：1 case-control study, prenatal and perinatal data were collected and analyzed between preterm infants with PV-IVH and control group from January 2012 to October 2014. The risk and protective factors for the PV-IVH were identified by univariate analysis and multivariate conditional logistic regression analysis. Results There were one hundred and thirty-two preterm infants diagnosed of PV-IVH, in which, among whom 6 preterm infants could not be matched to the control infants in the protocol. Finally, 126 pairs of infants were enrolled in the study. There were no differences between two groups in gestational age and birth weight（all P〈0.05）. Multivariate conditional logistic regression analysis found that BE-5 mmol/L in the initial blood gas analysis after birth（OR=1.986, 95.0% CI ：1.039-3.796）, mechanical ventilation（OR=2.913, 95% CI ：1.390-6.101）, weight gain ≤10 g/d in the second week（OR=2.303, 95% CI ：1.164-4.558） were risk factors, while number of previous pregnancies ≥1 times（OR=0.426, 95% CI ： 0.229-0.792） was a protective factor for PV-IVH. Conclusions The risk factors of PV-IVH in preterm infants include the lower BE value in the initial blood gas analysis, required mechanical ventilation, and less weight gain in the second week.