早产儿脑损伤的临床特点和高危因素分析

Analysis of clinical characteristics and risk factors of brain injury in preterm infants

目的比较脑损伤和非脑损伤早产儿的临床特点,分析早产儿脑损伤的相关危险因素。方法回顾性分析2017年7月—2019年6月入住本院新生儿科、符合入选标准的274例早产儿的临床资料,根据头颅MRI表现将早产儿分为脑损伤组(84例)和非脑损伤组(190例)两组,比较两组患儿的临床特点,对脑损伤危险因素进行Logistic回归分析。结果早产儿脑损伤发生率为30.66%(84/274),Apgar评分1 min≤7分、应用血管活性药物及胎膜早破为早产儿脑损伤的危险因素(P=0.001、0.023、0.029),剖宫产是早产儿脑损伤的保护性因素(P=0.003)。脑损伤组早产儿惊厥、呼吸暂停、喂养困难、低甲状腺素血症、贫血发生率显著高于非脑损伤组(P<0.05),静脉营养持续时间和住院天数较非脑损伤早产儿显著延长(P<0.05)。结论围生期窒息、感染、血流动力学不稳定均为早产儿脑损伤发生的危险因素,其临床表现不局限与神经系统,对有上述病史和临床表现的早产儿需及早干预,动态随访,改善脑损伤早产儿预后。

Objective To explore the risk factors of brain injury in preterm infants throughout comparing the clinical characteristics of preterm infants with brain injury and without brain injury.Methods Clinical data of 274 preterm infants admitted todepartment of neonatology in affiliated hospital of Nantong University from July 2017 to June 2019 and met the include criteriawere studied retrospectively.All objects received brain magnetic resonance imaging(MRI)during hospitalization and were divided into brain injury group n=84)and non brain injury group(n=190)according to the MRI results.The clinical characteristics of the two groups of preterm infantswere compared.The risk factors of brain injury were performed by logistic analysis.Results The incidence of brain injury among preterm infants were 30.66%(84/274),1 minute Apgar score equal or less than 7,use of vasoactive agents and premature rupture of fetal membranes were independent risk factors of brain injury in preterm infants(P=0.001,0.023,0.029),and uterine-incision delivery was a protective factor of brain injury(P=0.003).The occurrence of convulsion,apnea,intolerance to feed,hypothyroxinemia and anemia was significantly were higher in brain injury group(P<0.05),and the duration of parenteral nutrition and hospital stay were longer than the preterm infants without brain injury(P<0.05).Conclusions Perinatal asphyxia,infection and hemodynamic disorder could all dedicate to brain injury in preterm infants.Clinical presentations of brain injury in preterm infants are multitudinous,not only limited to nervous system.Clinicians should be sensitive to the risk factors and presentations mentioned above,take related intervention strategies in early stage so as to improve prognosis of this particular group.