胎龄≤33周早产儿脑白质损伤的产前、产时和产后高危因素探讨

High risk factors of cerebral white matter injury in prenatal,intrapartum and postpartum for preterm infants with gestational age ≤33 weeks

目的前瞻性观察胎龄≤33周早产儿脑白质损伤的发生率,分析产前、产时和产后高危因素,探讨早产儿脑白质损伤的防治策略。方法选择2015年1月至2016年6月共531例胎龄≤33周早产儿纳入研究,连续头颅超声检查4周确定是否发生脑白质损伤,对早产儿脑白质损伤的产前、产时和产后相关高危因素进行单因素及多因素Logistic回归分析。结果胎龄≤33周早产儿脑白质损伤发生率为8.1%(43/531)。单因素分析显示:胎龄、出生体质量、1'Apgar评分、重度窒息、呼吸暂停、特发性呼吸窘迫综合征(RDS)、肺出血、新型支气管肺发育不良(BPD)、BPD激素治疗、持续正压通气(CPAP)吸氧时间、机械通气时间、补充肺表面活性物质(PS)、早产儿视网膜病(ROP)、机械通气、低碳酸血症、总吸氧时间、口服布洛芬治疗动脉导管未闭(PDA)、高血糖、消化道出血和生后2周血钠水平与早产儿脑白质损伤相关(P<0.05,P<0.01)。对上述20个危险因素进行Logistic回归分析,发现肺出血(OR:3.776,95%CI:1.081~13.191,P=0.037)和低钠血症(OR:0.924,95%CI:0.855~1.000,P=0.049)是早产儿脑白质损伤的独立危险因素。结论胎龄≤33周早产儿脑白质损伤发生率是8.1%,预防早产、防治肺出血和低钠血症是减少早产儿脑白质损伤的重要措施。

Objective To prospectively observe the incidence of cerebral white matter injury in preterm infants with gestational age ≤33 weeks,analyze the high risk factors of prenatal,intrapartum and postpartum and explore the prevention and control strategies of cerebral white matter injury in preterm infants. Methods A total of 531 preterm infants with gestational age ≤33 weeks from January 2015 to June 2016 were included in this study. Continuous cranial ultrasonography examination for 4 weeks was performed to determine whether the cerebral white matter injury occurred. Single factor and multiple factor Logistic regression analyses were carried on to analyze the high risk factors of cerebral white matter injury in prenatal,intrapartum and postpartum for preterm infants. Results The incidence of cerebral white matter injury in preterm infants with gestational age ≤33 weeks was 8. 1%. Single factor analysis showed that gestational age,birth body mass,1-minute Apgar score,severe asphyxia,apnea,idiopathic respiratory distress syndrome（ RDS）,pulmonary hemorrhage,new bronchopulmonary dysplasia（ BPD）,use of hormones for BPD,oxygen inhalation time of continuous positive pressure ventilation（ CPAP）,mechanical ventilation time,supplementation of pulmonary surfactant（ PS）,retinopathy of prematurity（ ROP）,mechanical ventilation,hypocapnia,total days of oxygen inhalation,taking ibuprofen orally for the treatment of patent ductus arteriosus（ PDA）,hyperglycemia,gastrointestinal bleeding and blood sodium level at 2 weeks after birth were associated with brain white matter injury in preterm infants（ P〈0. 05 or P〈0. 01）. Logistic regression analysis for the above 20 high risk factors showed that pulmonary hemorrhage（ OR： 3. 776,95% CI： 1. 081-13. 191,P = 0. 037） and hyponatremia（ OR： 0. 924,95% CI： 0. 855-1. 000,P = 0. 049） were the independent risk factors of cerebral white matter injury in preterm infants. Conclusions The incidence of cerebral white matter injury in preterm infants with gestational age ≤ 33 weeks is 8. 1%. Prevention of premature labor,prevention and treatment of pulmonary hemorrhage and hyponatremia are the important measures for reducing the brain white matter injury in preterm infants.