早产儿视网膜病变发病情况对比研究

A comparative study of retinopathy of prematurity during different times in a single tertiary neonatal center

目的分析早产儿视网膜病变(ROP)发病率和危险因素随时间的变化情况。方法对2009—2011年,2012—2014年在本院新生儿重症监护病房住院的早产儿进行眼底检查,比较两时间段的ROP发病率及其危险因素。结果 2009—2011年614例早产儿中ROP 68例(11.1%),2012—2014年794例早产儿中ROP 121例(15.2%),差异有统计学意义(P<0.05)。2009—2011年3期以上或阈值病变10例,发病率14.7%,2012—2014年12例,发病率9.9%,差异有统计学意义(P<0.05)。2009—2011年胎龄、出生体重、吸氧时间、机械通气为早产儿发生ROP的独立危险因素,应用肺表面活性物质(PS)为保护性因素;2012—2014年胎龄、机械通气、输血为早产儿发生ROP的独立危险因素,应用PS为保护性因素。2012—2014年早产儿胎龄低于2009—2011年,差异有统计学意义(P<0.05),而用氧时间、机械通气、应用PS、输血比例均高于2009—2011年,差异有统计学意义(P<0.05)。结论早产儿ROP发病率有升高趋势,降低早产儿发生率,缩短氧疗时间,以及减少机械通气、输血比例对预防该病发生具有重要作用,同时减少有创通气使用、降低吸氧浓度、合理PS替代治疗,以及重视早期筛查是预防ROP严重病例的重要手段。

Objective To study the incidence and risk factors of retinopathy of prematurity （ROP） in a single tertiary center during different times（Phase 1：2009 to 2011;Phase 2：2012 to 2014）. Methods From 2009 to 2014, fundus examinations were performed on premature infants admitted to NICU of our hospital. The incidence and risk factors of ROP were compared between the two phases. Results During Phase 1,68 （11. 1% ） cases were diagnosed with ROP among 614 premature infants. During Phase 2, 121 （15. 2% ） cases were diagnosed with ROP among 794 premature infants. The incidences of ROP between the two phases were significantly different （P 〈0. 05）. During Phase 1 and 2, 10 （14. 7% ） infants and 12 （9. 9% ） infants were diagnosed with Grade 3 and above or threshold ROP, respectively. The incidence of Grade 3 and above or threshold ROP between the two phases were also significantly different （P 〈 0. 05）. Logistic analysis demonstrated that gestational age（GA）, birth weight （BW）, duration of oxygen therapy and mechanical ventilation（MV） were independent risk factors during hase 1, whereas GA, MV and blood transfusion were independent risk factors during Phase 2. Pulmonary surfactant （PS） was protective factor of ROP in both two groups. GA in Phase 2 was significant lower than Phase 1 （P 〈0. 05）, while duration of oxygen therapy, incidence of MV, PS and blood transfusion were＆amp;nbsp;higher in Phase 2 （ P 〈 0. 05） . Conclusions The incidence of ROP has increased. Reducing the incidence of preterm delivery, duration of oxygen therapy, incidence of MV and blood transfusion has important role in preventing ROP. Reducing the use of MV and the oxygen concentrations, appropriate PS therapy and focusing on early ophthalmic screening are important preventing severe ROP.