新生儿脑梗死的危险因素

Risk Factors for Neonates with Cerebral Infarction

目的:探讨新生儿脑梗死的危险因素,同时与缺氧缺血性脑病(HIE)组和对照组进行比较。方法:采用回顾性分析方法,将2003年8月至2020年9月入住新生儿重症监护病房的52例脑梗死患儿作为脑梗死组,纳入2016年12月至2017年12月住院的单纯肺炎或病理性黄疸的新生儿145例作为对照组,2005年2月至2017年12月住院的211例HIE患儿作为HIE组,应用Logistic回归分析探讨新生儿脑梗死的危险因素。结果:脑梗死组紧急剖宫产、宫内窘迫、羊水粪染、脐带绕颈、窒息、新生儿复苏、5 min Apgar评分<7分、凝血功能障碍、红细胞增多症和新生儿低血糖的比例均高于对照组(P<0.05)。脐带异常(OR=2.490,95%CI 1.111~5.585)和胎儿宫内窘迫(OR=5.293,95%CI 1.935~14.475)为新生儿脑梗死的危险因素(P<0.05)。脑梗死组和HIE组在围产期缺氧事件的发生率均高于对照组。结论:脐带异常和胎儿宫内窘迫可增加新生儿发生脑梗死的风险;建议关注围产期缺氧,以减少新生儿脑梗死的发生。

Objective:To probe into the risk factors for neonates with cerebral infarction,and compare with those neonates in the control group and neonates with hypoxic ischemic encephalopathy(HIE).Methods:Retrospective analysis was performed on 52 neonates with cerebral infarction admitted into the neonatal intensive care unit from Aug.2003 to Sept.2020(cerebral infarction group),and a total of 145 neonates with neonatal pneumonia or neonatal hyperbilirubinemia admitted into the hospital from Dec.2016 to Dec.2017 were enrolled as the control group.Totally 211 neonates with HIE admitted into the hospital from Feb.2005 to Dec.2017 were enrolled as the HIE group.Logistic regression analysis was used to screen out the risk factors for cerebral infarction in neonates.Results:Compared with the control group,the cerebral infarction group had significantly higher percentages of emergency cesarean,fetal distress,meconium-stained amniotic fluid,cord entanglement,asphyxia,resuscitation in neonates,5 min Apgar<7 scores,abnormal coagulation,polycythemia and neonatal hypoglycemia(P<0.05).Cord abnormalities(OR=2.490,95%CI from 1.111 to 5.585)and fetal distress(OR=5.293,95%CI from 1.935 to 14.475)were independent risk factors for cerebral infarction in neonates(P<0.05).The incidence of perinatal hypoxic events in cerebral infarction group and HIE group was higher than that in control group.Conclusion:Cord abnormalities and fetal distress can increase the risk of neonatal cerebral infarction,it is suggested to pay close attention to perinatal hypoxia to reduce the incidence of neonatal cerebral infarction.