早产儿视网膜病变的筛查和危险因素分析

Screening of retinopathy of prematurity infants and the analysis of risk factors

目的了解早产儿视网膜病变(retinopathy of prematurity,ROP)的发病情况,并分析与ROP相关的危险因素。方法将2013年9月至2014年11月在本院新生儿科住院治疗的出生体重≤2500g或胎龄≤36周的早产儿,或超过以上标准但患有严重疾病的早产儿作为筛查对象,共582例,采用广角数码儿童视网膜成像系统(Ret CamⅢ)进行筛查,达到阈值病变或阈值前病变Ⅰ型的ROP及时行激光光凝治疗,所有患儿随访至视网膜血管完全周边化或病变退化。结果所有受检早产儿中65例发生ROP,发病率11.17%,其中1期23例,2期26例,3期12例,4期2例,急进性后极部型ROP 1例,退行性病变1例,达到阈值病变或阈值前病变Ⅰ型的10例,占筛查早产儿的1.72%。ROP的危险因素分析发现,胎龄越小,出生体重越低,ROP的发病率越高,同时氧疗、败血症、休克、RDS、贫血输血也是ROP发生的危险因素。结论本地区早产儿ROP总体发病率11.17%,胎龄、出生体重、氧疗、败血症、休克、RDS、贫血输血与ROP的发生有关。

Objective Investigate the incidence of retinopathy in premature infants and analyse the risk ＂factors of ROP. Methods 582 cases of premature infants whose birth weight no more than 2500g or gestational age less than 36 weeks or more than the above standard but suffered from serious disease, in the department of neonatology of our hospital from September 2013 to November 2014, were selected as the study objects for screening. The wide - angle digital children retinal imaging system （ RetCam III ） was used for screening, ROP reached the threshold lesions or type I lesion before threshold were treated by laser photocoagulation timely, all sick infants were followed up until retinal blood vessels turned to around completely or lesions degradation. Results 65 cases of ROP were occurred in all the premature infants, the incidence was 11.17%. Among them, 23 cases in phase 1, 26 cases in phase 2, 12 cases in phase 3, 2 cases in phase 4A, 1 case was rapidly progressive posterior pole type, 1 case suffered from degenerative disease, 10 cases reached the threshold lesions or type I lesion before threshold, which accounted for 1.72% of the screening premature infants. The conclusion of risk factors for ROP analysis indicated that the smaller the gestational age was, the lower the birth weight was, the higher the incidence of ROP. Oxygen, therapy, sepsis, shock, RDS and anemia blood transfusion were also the risk factors for the occurrence of ROP. Conclusions Overall incidence of ROP in premature infants in the region is 11.17%. The occurrence related to gestational age, birth weight, oxygen, therapy, sepsis, shock, RDS,anemia and transfusion.