高危新生儿视网膜出血的原因分析

CLINICAL ANALYSIS OF CAUSES OF RETINAL HEMORRHAGE IN HIGH-RISK NEONATES

目的探讨高危新生儿视网膜出血的原因,并分析其影响因素。方法出生1~7d有早产、窒息或难产史等高危因素的新生儿526例,散瞳后用儿童广域视网膜成像系统进行眼底检查,记录视网膜出血情况,按出血程度分为1、2、3度。对不同程度视网膜出血与窒息程度、分娩方式的关系进行分析。结果 526例高危新生儿出现视网膜出血者110例,发生率为21%。经阴道分娩418例,出现视网膜出血98例,发生率23.4%。新生儿视网膜出血主要表现为视网膜浅层出血。视网膜出血发生与新生儿性别、出生体质量差异无关(P>0.05);与分娩方式相关,经阴道分娩引起的视网膜出血发生率较剖宫产高,差异有显著性(χ~2=36.999,P<0.01)。视网膜出血程度与窒息的程度有明显相关性,重度窒息较轻度窒息更容易引起新生儿视网膜出血(χ~2=6.172,P<0.05)。结论高危新生儿视网膜出血发生与性别和出生体质量无关,与窒息和分娩方式有关,一般出血2个月内能完全吸收。

Objective To explore the causes of retinal hemorrhage in high-risk neonates, and to analyze the influencing factors. Methods A total of 526 neonates （1-7 days after birth） with high-risk factors such as preterm birth, asphyxiation, and difficult birth were examined using the Retcam Ⅲ wide-field imaging system after mydriasis to record retinal hemorrhage. Ac- cording to the degree of bleeding, these subjects were classified into 1,2, and 3 degrees. The relationship of the degree of retinal hemorrhage with the degree of suffocation and the mode of delivery was analyzed. Results Among the 526 high-risk neonates, 110 （21%） had retinal hemorrhage. Among the 418 neonates born by vaginal delivery,98 （23.4%） had retinal hemorrhage. Neo- natal retinal hemorrhage mainly manifested as superficial hemorrhage of the optic network. Neonatal retinal hemorrhage was not related to sex and birth weight （P：〉0.05） ; the incidence of retinal hemorrhage was significantly higher in the neonates born by va ginal delivery than in those born hy cesarean section （X^2 =36.999 ,P〈0.01）. The degree of retinal hemorrhage was significantly re- lated to the degree of asphyxia （X^2 = 6.172, P〈0.05） ; severe asphyxia was more likely to lead to retinal hemorrhage than mild as- phyxia. Conclusion Retinal hemorrhage in high-risk neonates is not associated with sex and birth weight, but is associated with asphyxiation and the mode of delivery, which can be absorbed completely within 2 months.