自然分娩高危新生儿视网膜出血的临床观察及相关因素分析

A study on the risk factors of retinal hemorrhage in high-risk newborns of spontaneous vaginal delivery

目的观察自然分娩高危新生儿视网膜出血发生情况,探讨其影响因素。方法选择2012年9月至2015年6月在本院出生,入住新生儿重症监护病房的自然分娩高危新生儿。采用第三代广角数码视网膜成像系统RetCamⅢ进行眼底检查,出血程度分为Ⅰ、Ⅱ、Ⅲ度。记录新生儿出生时情况及母亲孕期、分娩时状况,包括出生体重、是否早产、性别、有无窒息、有无头颅血肿、是否颅内出血、有无胎儿宫内窘迫、产妇年龄、产次、产程、母亲产前并发症。采用单因素卡方检验和多因素Logistic回归检验,分析自然分娩高危新生儿发生视网膜出血的危险因素。结果共纳入1 345例顺产高危新生儿,其中视网膜出血437例,占32.5%。437例视网膜出血患儿中,Ⅰ度视网膜出血166例,占38.0%,Ⅱ度106例,占24.3%,Ⅲ度165例,占37.8%。单眼视网膜出血190例,双眼视网膜出血247例。6例出现玻璃体积血。单因素分析发现,窒息(x^2=43.576)、头颅血肿(x^2=4.256)、颅内出血(x^2=3.871)、急产(x^2=28.499)、产次(x^2=6.112)与自然分娩高危新生儿视网膜出血发生有相关性(P<0.05)。Logistic回归分析显示,窒息、头颅血肿、颅内出血、急产和产次是自然分娩高危新生儿视网膜出血可能危险因素(OR分别为2.597、1.708、1.669、2.729、1.421,P<0.05)。而性别、孕周、出生体重、宫内窘迫、母亲年龄、母亲并发症与自然分娩高危新生儿视网膜出血均无相关性(P>0.05)。结论自然分娩高危新生儿视网膜出血发生率为32.5%,窒息、头皮血肿、颅内出血、急产和分娩次数是视网膜出血的高危因素。

Objective To study the characteristics and risk factors of retinal hemorrhage in high-risk newborns of spontaneous vaginal delivery. 1 345 high-risk newborns with history of high-risk Methods From September 2012 to June 2015, pregnancy and/or neonatal asphyxia born in our hospital and admitted to the neonatal intensive care unit were enrolled and clinical data recorded, including birth weight （BW）, gestational age （GA）, gender, asphyxia, scalp hematoma, intracranial hemorrhage （ ICH）, intrauterine distress, maternal age, parity history, stages of labor and antenatal complications, such as pregnancy-induced hypertension. Fundus examinations were performed using retina imaging system （RetCam Ⅲ ）, and retinal hemorrhage 1I according to the area of the hemorrhage. Chi-square tests was graded into three degrees of Ⅰ , Ⅱ or and Logistic regression analysis were used to determine the risk factors of retinal hemorrhage in high risk newborns. Results Retinal hemorrhage was found in 437 newborns （ 32.5% ）, 166 cases （ 38.0% ） grade I , 106 cases （ 24. 3% ） grade Ⅱ and 165 cases（37.8% ） grade m. of the 437 cases, 190（43.5% ） had hemorrhages in only one eye and 247 （56.5%） both eyes. 6 cases had vitreous hemorrhage. Chi-square tests showed that asphyxia （χ2 = 43. 576, P 〈0.05）, scalp hematoma （χ2 =4.256, P 〈0.05）, ICH （χ2 =3.871, P 〈0.05）, precipitate labor （χ2 = 28.499, P 〈 0. 05 ） and parity history （χ2 = 6. 112, P 〈 0.05 ） were associated with retinal hemorrhage. Logistic regression analysis indicated that asphyxia, scalp hematoma, ICH, precipitate labour and parity history were the risk factors of retinal hemorrhage in high-risk newborns （OR = 2. 597, 1. 708, 1. 669, 2. 729, 1. 421）. While gender, GA, BW, fetal intrauterine distress, maternal age and antenatal complications had no significant correlations （P 〉 0. 05 ）. Conclusions The incidence of retinal hemorrhage in high-risk newboms of spontaneous vaginal delivery was 32.5%. Neonatal asphyxia, scalp hematoma, ICH, precipitate labor and parity history were the risk factors for retinal hemorrhage in high-risk newborns.