早产儿视网膜病变的影响因素及治疗效果分析

Analysis of influencing factors and treatment effects of retinopathy of prematurity in hospitalized premature infants

目的分析早产儿视网膜病变(ROP)的影响因素及治疗效果。方法回顾性队列研究。纳入于徐州市第一人民医院2020年2月至2022年12月住院接受眼底筛查的698例早产儿,根据筛查结果分为ROP组(105例)及非ROP组(593例)。收集出生孕周、出生体重、胎数、母亲孕期合并症、分娩方式、1~5 min Apgar评分、是否吸氧、其他系统疾病等早产儿及产妇临床资料,分析影响ROP发病危险因素。随访6个月,观察玻璃体内注射雷珠单抗(IVR)的效果。结果ROP组患儿出生体重[(1608.52±527.22)g]、1 min Apgar评分[(4.52±2.04)分]、5 min Apgar评分[(7.00±1.46)分]、短胎龄[88例(83.81%)]、吸氧[71例(67.62%)]、机械通气[62例(59.05%)]、出生并发窒息[54例(51.43%)]、并发呼吸窘迫[37例(35.24%)]、并发肺炎[89例(84.76%)]比例均与非ROP组患儿出生体重[(2513.19±842.70)g]、1 min Apgar评分[(6.67±2.00)分)、5 min Apgar评分[(8.41±1.26)分]、短胎龄[298例(50.25%)]、吸氧[128例(21.59%)]、机械通气[223例(37.61%)]、出生并发窒息[217例(36.60%)]、并发呼吸窘迫[36例(6.07%)]、并发肺炎[298例(50.25%)]的差异有统计学意义(t=-10.63,P<0.001;t=-9.96,P<0.001;t=-9.27,P<0.001;χ^(2)=40.64,P<0.001;χ^(2)=92.75,P<0.001;χ^(2)=16.98,P<0.001;χ^(2)=8.27,P=0.004;χ^(2)=81.04,P<0.001;χ^(2)=43.00,P<0.001);与非ROP组产妇胎盘早剥[153例(25.80%)]、胎膜早破[282例(47.56%)]比例相比,ROP组产妇胎盘早剥[73例(69.52%)]、胎膜早破[80例(76.19%)]比例较高(χ^(2)=77.89,P<0.001;χ^(2)=29.30,P<0.001);二元Logistic回归分析:胎龄>34周(OR=0.41,P=0.021)、出生体重≥2255.00 g(OR=0.11,P<0.001)、单胎妊娠(OR=0.43,P=0.014)及5 min Apgar评分≥9.00分(OR=0.13,P=0.027)是ROP发病的独立保护因素;吸氧(OR=21.23,P=0.002)、合并呼吸窘迫(OR=2.99,P=0.025)及产妇胎盘早剥(OR=6.63,P=0.011)是ROP发病的独立危险因素。IVR临床治疗结果分析:64只眼接受IVR治疗,其中43只眼完全治愈,治愈率为67.19%。治疗不良反应:2例出现玻璃体混浊,1例出现局部出血,1例出现视网膜出血,总发生率为6.25%(4/64)。结论出生体重低、短胎龄、吸氧、合并呼吸窘迫及产妇胎盘早剥等与住院ROP发病相关,患眼接受IVR治疗后痊愈率高,不良反应少。

ObjectiveTo analyze the influencing factors and treatment efficacy of retinopathy of prematurity(ROP)in hospitalized infants.MethodsThis was a retrospective cohort study.A total of 698 preterm infants who received fundus screening in Xuzhou First People′s Hospital from Feb.2020 to Dec.2022 were included.Based on the screening results,they were divided into an ROP group(105 cases)and a non-ROP group(593 cases).The clinical data of gestational age,birth weight,fetuses number,complications during pregnacy,delivery mode and Apgar scores in 1 to 5 minutes,history of oxygen inhalation,and other systemic diseases in preterm infants and puerpera were collected.The risk factors affecting the incidence of ROP were analyzed,and the efficacy of intravitreal injection of ranibizumab(IVR)were observed.The follow-up time was 6 months.ResultsBirth weight[(1608.52±527.22)g],1 min apgar score[(4.52±2.04)scores],5 min apgar score[(7.00±1.46)scores],short gestational age[88 cases(83.81%)],oxygen inhalation[71 cases(67.62%)],mechanical ventilation[62 cases(59.05%)],asphyxia[54 cases(51.43%)],respiratory distress[37 cases(35.24%)],and pneumonia[89 cases(84.76%)]of infants in the ROP group all showed statistically significant differences when compared to the birth weight[(2513.19±842.70)g],1 min Apgar score[(6.67±2.00)scores],5 min Apgar score[(8.41±1.26)scores],short gestational age[298 cases(50.25%)],oxygen inhalation[128 cases(21.59%)],mechanical ventilation[223 cases(37.61%)],asphyxia[217 cases(36.60%)],respiratory distress[36 cases(6.07%)],and pneumonia[298 cases(50.25%)]of the non-ROP group(t=-10.63,P<0.001;t=-9.96,P<0.001;t=-9.27,P<0.001;χ^(2)=40.64,P<0.001;χ^(2)=92.75,P<0.001;χ^(2)=16.98,P<0.001;χ^(2)=8.27,P=0.004;χ^(2)=81.04,P<0.001;χ^(2)=43.00,P<0.001).Compared to the placental abruption[153 cases(25.80%)]and premature rupture of membranes[282 cases(47.56%)]of postpartum women in the non-ROP group,there was a higher percentage of placental abruption[73 cases(69.52%)]and premature rupture of membranes[80 cases(76.19%)]in the ROP group(χ^(2)=77.89,P<0.001;χ^(2)=29.30,P<0.001).Binary Logistic regression analysis:gestational age>34 weeks(OR=0.41,P=0.021),birth weight≥2255.00 g(OR=0.11,P<0.001),singleton pregnancies(OR=0.43,P=0.014)and 5 min Apgar score≥9.00 scores(OR=0.13,P=0.027)were independent protective factors for the incidence of ROP,respectively.Oxygen inhalation(OR=21.23,P=0.002),combined with respiratory distress(OR=2.99,P=0.025),placental abruption(OR=6.63,P=0.011)were the independent risk factors for ROP,respectively.IVR treatment analysis:a total of 64 eyes received IVR treatment with 43 eyes completely cured,and the cure rate was 67.19%.Treatment adverse reactions:vitreous opacity occurred in 2 cases,local bleeding occurred in 1 case,and retinal bleeding occurred in 1 case,with a total incidence of 6.25%(4/64).ConclusionLow birth weight,short gestational age,oxygen inhalation,combined with respiratory distress,placental abruption are associated with the onset of ROP in hospitalization.After receiving IVR treatment,the recovery rate of ROP in hospitalized premature infants is high and there are fewer adverse reactions.