早产儿颅内出血的影响因素分析

Analysis of high-risk factors for intracranial hemorrhage in the preterm infants

目的探讨早产儿颅内出血(intracranial hemorrhage,ICH)的高危因素。方法收集2019年1月至2019年6月武汉大学中南医院新生儿科收治的283例早产儿病历资料,采用MRI检测早产儿颅内出血情况,并对早产儿颅内出血相关因素进行Logistic回归分析。结果283例早产儿中经MRI检测有68例发生ICH,占比24.0%,ICH类型以脑室周围-脑室内出血(periventricular-intraventricular hemorrhage,PVH-IVH)最为多见(11.0%)。单因素分析显示,胎龄(χ^(2)=29.438,P<0.001)、娩出方式(χ^(2)=30.576,P<0.001)、皮肤出血(χ^(2)=18.219,P<0.001)和宫内窘迫(χ^(2)=9.690,P=0.002)等10项指标在ICH和非ICH早产儿组间存在显著差异。Logistic多因素回归分析表明,胎龄<32周[OR=4.830,95%CI(2.385,9.785)]、顺产[OR=6.510,95%CI(3.245,13.062)]、皮肤出血[OR=2.559,95%CI(1.215,5.391)]和宫内窘迫[OR=5.424,95%CI(2.061,14.277)]的早产儿更易发生ICH。结论PVH-IVH是早产儿最常见的ICH类型,胎龄<32周、顺产、皮肤出血和宫内窘迫是早产儿发生ICH的独立危险因素,临床医生需尽早做出预防措施,减少早产儿ICH的发生。

Objective To explore the high-risk factors for intracranial hemorrhage(ICH)in preterm infants.Methods We accessed the medical records of 283 preterm infants hospitalized from January 2019 to June 2019 in Zhongnan Hospital of Wuhan University,where MRI was to detect ICH in preterm infants.Logistic regression analysis of the factors related to ICH were conducted in all selected preterm infants.Results ICH,was detected by MRI in 68 preterm infants,representing 24.0%,and PVH-IVH(periventricular-intraventricular hemorrhage)was the most common type,with a detection rate of 11.0%.Single-factor analysis showed that there were ten factors showing statistically significant differences between the ICH and non-ICH groups such as gestational age(χ^(2)=29.438,P<0.001),delivery mode(χ^(2)=30.576,P<0.001),postnatal skin bleeding(χ^(2)=18.219,P<0.001)and intrauterine distress(χ^(2)=9.690,P=0.002).Multivariate logistic regression analysis showed that preterm infants with gestation age<32 weeks(OR=4.830,95%CI:2.385~9.785,P<0.05),eutocia(OR=6.510,95%CI:3.245~13.062,P<0.05),intrauterine distress(OR=5.424,95%CI:2.061~14.277,P<0.05)and postnatal skin bleeding(OR=2.559,95%CI:1.215~5.391,P<0.05)are more prone to ICH.Conclusion The most common type of ICH in preterm infants is PVH-IVH.Eutocia,intrauterine distress,postnatal skin bleeding and gestational age lower than 32 weeks are high-risk factors for ICH in preterm infants.Clinicians should take prevention and treatment measures as soon as possible to reduce the occurrence of ICH.