早产儿视网膜病变的筛查和危险因素分析

Retinopathy of prematurity screening in 360 premature infants

目的 了解早产儿视网膜病变(retinopathy of prematurity, ROP)的发病情况及其主要危险因素。方法 将2020年1月—2021年10月娄底市中心医院新生儿重症监护病房收治的360例早产儿纳入研究,采用RetcamⅢ对其进行眼底筛查。根据早产儿是否发生ROP分为ROP组和非ROP组,比较两组早产儿的临床资料,并对其相关危险因素进行分析。结果 符合纳入标准的360例早产儿中,ROP组37例(10.3%),非ROP组323例(89.7%)。出生胎龄<28周早产儿ROP检出率为77.8%,出生体质量≤1 000 g早产儿ROP检出率为66.7%,明显高于其他出生胎龄、出生体质量新生儿ROP检出率,差异均有统计学意义(均P<0.05)。单因素分析结果显示,早产儿胎龄、出生体质量、1 min Apgar评分、多胎妊娠、新生儿动脉导管未闭、先天性支气管肺发育不良、新生儿肺透明膜病、新生儿低蛋白血症、新生儿贫血、输血及母亲年龄在两组间比较,差异均有统计学意义(均P<0.05)。多元logistic回归分析结果显示,低胎龄、低出生体质量、多胎妊娠及输血是ROP发病的危险因素(P<0.05)。结论 低胎龄、低出生体质量、输血及多胎妊娠是ROP的主要危险因素。对于合并这些危险因素的早产儿需重点筛查,实现早发现、早治疗,以降低儿童致盲率。

Objective To explore the incidence and high risk factors of retinopathy of prematurity(ROP).Methods Retrospective study.From January 2020 to October 2021,360 premature infants who were admitted to the neonatal intensive care unit(NICU) of Loudi Central Hospital were included in the study, and fundus screening was performed by Retcam Ⅲ.Preterm infants were divided into ROP group and non-ROP group according to whether they developed retinopathy.Clinical data of the two groups of preterm infants were compared, and related risk factors were analyzed.Results Among 360 preterm infants meeting the inclusion criteria, 37( 10.3%) were in the ROP group and 323(89.7%) were in the non-ROP group.The detection rate of ROP in preterm infants with gestational age <28 weeks was 77.8%,and the detection rate of ROP in preterm infants with birth weight <1 000 g was 66.7%,which was significantly higher than that of other gestational age and birth weight(P<0.05).Univariate analysis showed that there were differences in gestational age, birth weight, 1 minute Apgar score, multiple births, patent ductus arteriosum, congenital bronchopulmonary dysplasia, hyaline membrane disease, hypoproteinemia, anemia, blood transfusion and maternal age between the two groups(P<0.05).Multiple logistic regression analysis showed that low gestational age, low birth weight, multiple births and transfusion were risk factors of retinopathy in preterm infants(P<0.05).Conclusion Low gestational age, low birth-weight, blood transfusion and multiple pregnancy are the main risk factors for ROP.For premature infants combined with these risk factors, it is necessary to focus on screening, to achieve early detection, early treatment, in order to reduce the rate of childhood blindness.