严格控制用氧的超低出生体重儿早产儿视网膜病变的相关因素分析

Risk factors of retinopathy of prematurity in extremely low birth weight infants by strictly controlling oxygen inhalation after birth

目的探讨严格控制用氧的超低出生体重(ELBW)儿生后早产儿视网膜病变(ROP)发病的相关因素。方法回顾性病例系列研究。纳入出生体重<1 000g并进行ROP筛查的ELBW儿166例。其中,男性79例,女性87例,出生孕周(27.99±1.73)周,出生体重(904.45±80.23)g。根据最终筛查结果将受检儿分组如下:(1)按有无ROP分为ROP组与非ROP组;(2)按ROP严重程度分为严重ROP组与轻或无ROP组。记录出生孕周、出生体重、是否为试管婴儿、胎数、母亲孕期合并症、分娩方式、1~10 min Apgar评分、生后1~6周体重及体重增长率、生后喂养情况、是否吸氧及用氧情况、是否贫血及输血情况、其他系统疾病等,分析这些因素与严重ROP的相关性。结果166例ELBW儿中共筛查出ROP患儿94例,占56.63%。其中严重ROP患儿16例,占9.64%;治疗患儿14例,占8.43%。ROP组出生体重为(911.95±72.80)g、非ROP组为(894.67±88.58)g,差异无统计学意义(t=1.379,P=0.170);ROP组出生孕周为(27.49±1.53)周、非ROP组为(28.64±1.76)周,差异有统计学意义(t=-4.491,P<0.001);此外母亲孕期合并妊娠高血压(χ^2=4.479,P=0.034)、5 min(t=-2.760,P=0.006)及10 min(t=-2.099,P=0.043)Apgar评分、肺炎(χ^2=6.233,P=0.013)、新生儿肺炎(χ^2=18.026,P<0.001)间差异均有统计学意义;有无ROP对ELBW儿生后1~6周体重(F=0.009,P=0.753)及体重增长率无影响(F=2.394,P=0.124)。严重ROP组出生体重为(875.63±74.85)g、轻或无ROP组为(907.53±80.41)g,差异无统计学意义(t=-1.518,P=0.131);严重ROP组出生孕周为(26.88±1.31)周、轻或无ROP组为(28.11±1.73)周,差异有统计学意义(t=-2.766,P=0.006);此外仅眼底出血(χ^2=4.507,P=0.034)间差异有统计学意义;ROP严重程度对ELBW儿生后1~6周体重(F=2.683,P=0.103)及体重增长率无影响(F=0.431,P=0.513)。Logistic回归分析显示,仅出生孕周与ROP的发生(β=-0.437,P<0.001)及严重程度(β=-0.616,P=0.007)有关。结论通过严格控制ELBW儿生后用氧等相关因素,ELBW儿ROP的重症率低,而出生孕周仍是ELBW儿不可避免的ROP发病独立高危因素。

Objective To observe the incidence and severity of retinopathy of prematurity(ROP)in extremely low birth weight(ELBW)infants by strictly controlling the risk factors of ROP,such as oxygen inhalation after birth,to explore the related factors of ROP in ELBW infants.Methods This was a cross-sectional study.166 ELBW infants underwent neonatal screening were enrolled in this study,whose birth weight was less than 1 000 g.There were 79 males and 87 females infants,whose average gestational age was(27.99±1.73)weeks,and average birth weight was(904.45±80.23)g.According to the final screening results,the ELBW infants were grouped as follows:(1)ROP group and non-ROP group;(2)severe ROP group and mild or no ROP group.Risk factors included gestational age,birth weight,test-tube infants,fetuses number,complications during pregnancy,delivery mode and Apgar scores in 1 to 10 minutes,weight and weight gain proportion at 1-6 weeks after birth,postnatal feeding mode,history of oxygen inhalation,anemia and blood transfusion,and other systemic diseases were recorded.And their correlation with severe ROP was analyzed by SPSS 20.0 statistical software.Results Ninty-four(56.63%)ELBW infants developed ROP,16(9.64%)were severe ROP and 14(8.43%)received treatment.Average birth weight between ROP group(911.95±72.80)g and non-ROP group(894.67±88.58)g had no difference(t=1.379,P=0.170).Average gestational age between ROP group(27.49±1.53)weeks and non-ROP group(28.64±1.76)weeks had significant difference(t=-4.491,P<0.001).And pregnancy-induced hypertension during pregnancy(χ^2=4.479,P=0.034),Apgar score in 5 minutes(t=-2.760,P=0.006)and 10 minutes(t=-2.099,P=0.043),pneumonia(χ^2=6.233,P=0.013),neonatal pneumonia(χ^2=18.026,P<0.001)had significant difference between ROP group and non-ROP group.There was no effect on weight(F=0.009,P=0.753)or weight gain proportion(F=2.394,P=0.124)at 1-6 weeks after birth in ELBW infants with or without ROP.Average birth weight between severe ROP group(875.63±74.85)g and mild or no ROP group(907.53±80.41)g had no difference(t=-1.518,P=0.131).Average gestational age between severe ROP group(26.88±1.31)weeks and mild or no ROP group(28.11±1.73)weeks had significant difference(t=-2.766,P=0.006).And only fundus hemorrhage(χ^2=4.507,P=0.034)had significant difference between severe ROP group and mild or no ROP group.There was no effect on weight(F=2.683,P=0.103)or weight gain proportion(F=0.431,P=0.513)at 1-6 weeks after birth in ELBW infants with or without ROP.Logistic regression analysis revealed that only gestational age was correlated to the incidence(β=-0.437,P<0.001)and severity(β=-0.616,P=0.007)of ROP significantly.Conclusion By strictly controlling the risk factors of ROP,such as oxygen inhalation after birth,the severe rate of ROP in ELBW infants is low.However,gestational age is still the inevitable independent high risk factor for the incidence of ROP in ELBW infants.