早产儿颅内出血的高危因素及临床结局

High-risk Factors and Clinical Outcome of Intracranial Hemorrhage in Premature Infants

目的:分析早产儿颅内出血(ICH)的高危因素及临床结局。方法:选取69例ICH患儿作为ICH组,另选取80例同期未发生ICH的单纯早产儿作为对照组,采用单因素分析可能引起ICH的29种因素在2组早产儿间的差异,对有差异的因素再采用多因素逐步Logistic回归分析引起ICH的高危因素,记录ICH患儿出血程度与临床结局。结果:单因素分析结果显示,妊娠高血压综合征、前置胎盘、胎膜早破、胎儿宫内窘迫、孕周、产前应用地塞米松、产时窒息、低氧血症、高碳酸血症、代谢性酸中毒、机械通气、1 min新生儿(Apgar)评分、新生儿呼吸窘迫综合征、新生儿呼吸衰竭、新生儿呼吸暂停及新生儿吸入高浓度氧等17种因素在2组早产儿间比较,差异有统计学意义(P<0.05);Logistic逐步回归分析显示,胎儿宫内窘迫、产时窒息、低氧血症、高碳酸血症、代谢性酸中毒、机械通气、新生儿呼吸窘迫综合征、新生儿呼吸衰竭及新生儿呼吸暂停等9种因素与ICH的发生呈正相关(P<0.05)、是ICH的危险性因素(OR>1),孕周、出生体质量、产前应用地塞米松及1 min Apgar评分与ICH的发生呈负相关(P<0.05)、是ICH的保护性因素(OR<1);Ⅰ、Ⅱ度ICH患儿预后良好,Ⅲ、Ⅳ度患儿预后较差,神经系统后遗症发生率为63.64%。结论:胎儿宫内窘迫、产时窒息、低氧血症、高碳酸血症、代谢性酸中毒、机械通气、新生儿呼吸窘迫综合征、新生儿呼吸衰竭及新生儿呼吸暂停是ICH的危险因素,临床应给予重视。

Objective:TTo analyze the high-risk factors and clinical outcome of intracranial hemorrhage in premature infants.Methods:69 children with ICH were selected as ICH group,and another 80 premature infants with no ICH during the same period were selected as the control group.The difference of 29 factors that caused ICH between the two groups of premature infants by univariate analysis.The high risk factors of ICH caused by multivariate stepwise Logistic regression analysis were used to record the bleeding degree and clinical outcome of ICH children.Results:Univariate analysis showed that pregnancy induced hypertension syndrome,placenta previa,premature rupture of membranes,fetal distress,gestational weeks,antenatal use of dexamethasone,asphyxia during delivery,hypoxia,hypercapnia,metabolic acidosis,mechanical ventilation,1 min neonatal(Apgar)score,neonatal respiratory distress syndrome,neonatal respiratory failure,and there were significant differences in 17 factors,such as neonatal dyspnea and neonatal inhalation of high concentration of oxygen,between the two groups of premature infants(P<0.05).Logistic stepwise regression analysis showed that fetal distress,asphyxia during delivery,hypoxia,hypercapnia,metabolic acidosis,mechanical ventilation,neonatal respiratory distress syndrome,neonatal respiratory failure and neonatal dyspnea were positively correlated with the occurrence of ICH(P<0.05)and were the risk factors of ICH(OR>1).At gestational age,birth weight,antenatal use of dexamethasone and 1 min Apgar score were negatively correlated with the occurrence of ICH(P<0.05),which was a protective factor of ICH(OR<1).The prognosis of children with grade I andⅡwas good.The prognosis of children with gradeⅢandⅣwas poor,and the incidence of the sequela of the nervous system was 63.64%.Conclusion:Fetal distress,asphyxia during delivery,hypoxia,hypercapnia,metabolic acidosis,mechanical ventilation,neonatal respiratory distress syndrome,neonatal respiratory failure and neonatal dyspnea are the risk factors of ICH,which clinical attention should be paid to.