超早产儿脑室内出血的危险因素及大脑中动脉血流参数的预测价值

Risk factors of intraventricular hemorrhage in preterm infants and predictive value of middle cerebral artery blood flow parameters

目的分析超早产儿脑室内出血的危险因素及大脑中动脉(MCA)血流参数的预测价值。方法抽取2019年1月至2020年10月山西省儿童医院收治的61例脑室内出血超早产儿作为脑室内出血组,并以1∶1配比抽取同期收治的61例无脑室内出血超早产儿作为健康对照组,收集两组的临床资料,分析超早产儿发生脑室内出血的影响因素,并对比两组超早产儿出生后不同时间MCA血流参数[舒张期最高血流速度(Vd)、收缩期最高血流速度(Vs)、阻力指数(RI)]和观察组不同病情程度患儿出生后不同时间MCA Vd、Vs、RI的变化情况,分析相关性。结果性别、胎龄、出生体质量、分娩方式、有无胎儿宫内窘迫、有无机械通气、是否母体贫血、有无重度窒息史、有无新生儿糖代谢紊乱是超早产儿发生脑室内出血的影响因素(P<0.05)。出生后3、7 d,脑室内出血组Vd值较出生后1 d增高,但低于健康对照组,差异有统计学意义(P<0.05);出生后3、7 d,两组Vs值均较出生后1 d增高,且脑室内出血组低于健康对照组,差异有统计学意义(P<0.05);出生后7 d内,脑室内出血组患儿Vd、Vs值随出生时间增加而增高,且Ⅱ级患儿Vd、Vs值高于Ⅲ、Ⅳ级患儿,差异有统计学意义(P<0.05)。Pearson分析结果显示,Vd、Vs和超早产儿脑室内出血患儿出生时间呈正相关(r=0.649、0.705,P<0.05),Vd、Vs和病情程度呈负相关(r=-0.571、-0.613,P<0.05)。结论男性、胎龄小、出生体质量低、胎儿宫内窘迫、阴道分娩、机械通气、母亲贫血、重度窒息史、新生儿糖代谢紊乱是超早产儿发生脑室内出血的危险因素,且MCA的Vd、Vs参数和超早产儿脑室内出血病情程度具有相关性。

Objective To analyze the risk factors of intraventricular hemorrhage in preterm infants and the predictive value of blood flow parameters of middle cerebral artery(MCA).Methods Sixty-one premature infants with intraventricular hemorrhage treated in Children’s Hospital of Shanxi from January 2019 to October 2020 were selected as the intraventricular hemorrhage group,and 61 premature infants without intraventricular hemorrhage during the same period were selected as the healthy control group with a 1∶1 ratio.The clinical data of the two groups were collected,and the influencing factors of intraventricular hemorrhage in premature infants were analyzed.The blood flow parameters of MCA,including maximum diastolic blood flow velocity(Vd),maximum systolic blood flow velocity(Vs)and resistance index(RI),in the two groups at different times after birth were compared.And the changes of Vd,Vs,and RI of MCA at different times after birth in children with disease at degrees different in the observation group were compared,to analyzed the correlation of these indexes with duration after birth and disease severity.Results Gender,gestational age,birth weight,mode of delivery,fetal distress,mechanical ventilation,maternal anemia,severe asphyxia history,and neonatal glucose metabolism disorders were the influencing factors of intraventricular hemorrhage in premature infants(P<0.05).Three days and 7 days after birth,the Vd value of intraventricular hemorrhage group was higher than that 1 d after birth,but lower than that of control group,and the difference was statistically significant(P<0.05).Three days and 7 days after birth,the Vs values of the two groups were higher than those 1 d after birth,and the Vs values of intraventricular hemorrhage group was lower than that of control group(P<0.05).Within 7 days after birth,the Vd and Vs values of the intraventricular hemorrhage group increased with the increase of birth time,and the Vd and Vs values of gradeⅡchildren were higher than those of gradeⅢand grade IV children(P<0.05).Pearson analysis showed that Vd,Vs were positively correlated with birth time of premature infants with intraventricular hemorrhage(r=0.649,0.705;P<0.05);Vd,Vs and the severity of the disease were negatively correlated birth time of infants(r=-0.571,-0.613;P<0.05).Conclusions Male,small gestational age,low birth weight,fetal distress,vaginal delivery,mechanical ventilation,maternal anemia,history of severe asphyxia,and neonatal glucose metabolism disorders are risk factors for intraventricular hemorrhage in premature infants.The Vd and Vs parameters of MCA are correlated with the severity of intraventricular hemorrhage in ultra-premature infants.