早产儿脑损伤的类型及高危因素

Damage type and high-risk factors of brain injury in premature infants

目的:探讨早产儿脑损伤的类型及危险因素,为预防早产儿脑损伤提供依据。方法:收集胎龄<34周、共236例早产儿的临床资料,将早产儿分为有脑损伤组和无脑损伤组,分析产前、产时及产后因素对早产儿脑损伤的影响。采用logistic回归的方法分析早产儿脑损伤的高危因素。结果:早产儿脑损伤总发生率为4 0.7%(9 6/2 3 6),脑室周围-脑室内出血(periventricular intraventricular hemor rhage,PVH-IVH)发生率为16.1%(38/236),脑室周围白质软化(periventricular leukomalacia, P V L)发生率为1 1.8%(2 8/2 3 6)。9 6例早产儿脑损伤的患儿,出血性脑损伤占63.5%(61/96),以PVH-IVH为主,为62.3%(38/61);缺血性脑损伤占36.5%(35/96)。Logistic单因素回归分析提示胎龄、出生体重、剖宫产、胎膜早破>18 h、产后12 h内代谢性酸中毒、凝血功能障碍、低钙血症与早产儿脑损伤有关(P<0.05)。Logistic多因素回归分析提示剖宫产(OR=0.211,95%CI:0.111~0.402)是早产儿脑损伤的保护因素;胎龄<30周(OR=3.345,95%CI:1.214~9.219)、生后12h内代谢性酸中毒(OR=2.850,95%CI:1.332~6.099)、低钙血症(OR=2.553,95%CI:1.006~6.475)是早产儿脑损伤的危险因素。结论:胎龄及出生体重越小,早产儿脑损伤的发生率越高;PVH-IVH是最常见的脑损伤类型;剖宫产是早产儿脑损伤的保护因素,低胎龄、代谢性酸中毒与低钙血症是脑损伤的危险因素;加强围生期保健,预防早产,严格掌握剖宫产指征和维持生后内环境稳定,可减少早产儿脑损伤的发生。

Objective:To investigate the types and risk factors of brain injury in premature infants,and to provide basis for prevention and treatment of brain injury in premature infants.Methods:The clinical data of 236 premature infants<34 weeks were collected and divided into 2 groups:the group with brain injury and the group without brain injury.The effects of antepartum,intrapartum,and postpartum factors on brain injury in preterm infants were analyzed.Logistic regression model was used to analyze the risk factors for brain injury in premature infants.Results:The incidence of brain injury in premature infants was 40.7%(96/236),that of periventricular intraventricular hemor rhage (PVH-IVH) was 16.1% (38/236) and that of periventricular leukomalacia (PVL) was 11.8% (28/236). In 96 cases of premature infants with brain injury, 63.5% (61/96) was hemorrhagic brain injury, 62.3% (38/61) of which was PVH-IVH. Ischemic brain injury accounted for 36.5% (35/96). The results of the single-factor analysis showed that the differences between different gestational age, birth weight, cesarean section, premature rupture of membranes (>18 h), metabolic acidosis within 12 h after birth, coagulation dysfunction and hypocalcemia in the 2 groups were statistically significant (P<0.05). Multivariate Logistic regression analysis showed that cesarean section (OR=0.211, 95%CI 0.111 to 0.402) was a protective factor for brain injury in premature infants. Meanwhile, gestational age <30 weeks (OR =3.345, 95%CI 1.214 to 9.219), metacidosis within 12 h after birth (OR=2.850, 95%CI 1.332 to 6.099) and hypocalcemia (OR=2.553, 95%CI 1.006 to 6.475) were risk factors for brain injury in premature infants. Conclusion: Younger gestational age, and lower birth weight are related to a higher risk of brain injury in premature babies. PVH-IVH is the most common type of brain damage in premature infants. Cesarean section is a protective factor, while low gestational age, metabolic acidosis age and hypocalcemia are risk factors for brain injury in premature infants. Strengthening perinatal care, preventing premature birth, strict control of cesarean section, and maintaining stable postnatal internal environment stability can reduce the occurrence of brain injury in premature infants.