485例足月小样儿颅内出血危险因素分析

Clinical analysis of the risk factors of intracranial hemorrhage in 485 full-term small for gestational age infants

目的探讨足月小样儿发生颅内出血的类型及相关危险因素。方法回顾性分析485例足月小样儿的临床资料,分析颅内出血的围生期因素、颅内出血诊断前存在的合并症、头颅影像学检查结果及神经行为评分。结果 485例足月小样儿中,83例(17.1%)发生颅内出血。83例颅内出血患儿中,68例(81.9%)存在脑室周围及脑室内出血,其中Ⅰ度15例(22.1%)、Ⅱ度50例(73.5%)、Ⅲ度1例(1.5%)、Ⅳ度2例(2.9%);另15例(18.1%)主要为蛛网膜下隙出血(60%,9/15)。单因素分析发现,颅内出血组患儿的羊水污染率、新生儿硬肿症、动脉导管未闭患病率高于未发生颅内出血组,差异有统计学意义(P<0.05)。Logistic回归分析发现,羊水污染、新生儿硬肿症、动脉导管未闭为导致颅内出血的独立危险因素。结论足月小样儿发生颅内出血的类型为脑室周围及脑室内出血,羊水污染、新生儿硬肿症、动脉导管未闭为导致颅内出血的危险因素。

Objective To explore the types of intracranial hemorrhage （ICH） and its risk factors in full-term small for gestational age （SGA） infants. Methods The clinical data of 485 full-term SGA infants were retrospectively analyzed. Perinatal period factors, complications prior to diagnosis of intracranial hemorrhage, cranial imaging examination, and behavioral neurological assessment were analyzed. Results In 485 cases of full-term SGA infants, there were 83 cases （ 17 . 1%） of ICH, in whom 68 cases （ 81 . 9%） had periventricular hemorrhage or intraventricular hemorrhage with 15 cases （ 22 . 1%） of gradeⅠ, 50 cases （ 73 . 5%） of gradeⅡ, 1 case （ 1 . 5%） of gradeⅢand 2 cases （ 2 . 9%） of gradeⅣ. The remaining 15 cases were mainly subarachnoid hemorrhage （ 60%, 9/15 ）. Univariate analysis showed that the incidences of amniotic lfuid contamination, neonatal scleredema and patent ductus arteriosus were higher in ICH infants than those in non-ICH infants （all P〈0 . 05 ）. Logistic analysis showed that amniotic lfuid contamination, neonatal scleredema, and patent ductus arteriosus were the independent risk factors of ICH. Conclusions The types of ICH in full-term SGA infants was periventricular hemorrhage and intraventricular hemorrhage. Amniotic lfuid contamination, neonatal scleredema, and patent ductus arteriosus were the independent risk factors of ICH.