新生儿重症监护高危儿脑损伤的多因素风险评估与分析

Multivariate risk assessment and analysis of brain injury in high-risk infants in neonatal intensive care unit

目的 探讨新生儿重症监护病房(neonatal intensive care unit,NICU)高危儿脑损伤的危险因素。方法 选择芜湖市第二人民医院2019年3月至2023年3月收治的NICU高危儿655例作为研究对象,根据是否发生脑损伤将其分为脑损伤组(n=131)和无脑损伤组(n=524)。监测并记录两组基线资料、胎儿宫内窘迫(fetal distress in uterus,FDIU)、分娩方式、机械通气(mechanical ventilation,MV)、辅助生育技术、脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)、25羟基维生素D[25 hydroxyvitamin D,25(OH)D]等。以单因素分析、logistic回归分析方法分析影响NICU高危儿脑损伤的危险因素。结果 较无脑损伤组,脑损伤组低体质量例数、FDIU例数、MV例数、产前高危因素、母亲感染、BDNF和25(OH)D水平均较高(P<0.05)。Logistic回归分析示,低体质量、FDIU、MV、产前高危因素、母亲感染、BDNF、25(OH)D是影响NICU高危儿脑损伤的危险因素(P<0.05)。结论 低体质量、FDIU、MV、产前高危因素、母亲感染、BDNF、25(OH)D是影响NICU高危儿脑损伤的危险因素。在考虑上述因素基础上,在临床中可有针对性地防控干预,帮助降低脑损伤发生风险。

Objective To investigate the risk factors of brain injury in high-risk infants in neonatal intensive care unit(NICU).Methods A total of 655 high-risk NICU infants admitted to the second people's hospital of Wuhu from March 2019 to March 2023 were selected as the study objects,which were divided into brain injury group(n=131)and no brain injury group(n=524)according to whether brain injury occurred.Baseline data,fetal distress in uterus(FDIU),mode of delivery,mechanical ventilation(MV),assisted fertility technologies,brain-derived neurotrophic factor(BDNF),25 hydroxyvitamin D[25(OH)D]were monitored and recorded.Univariate analysis and logistic regression analysis were used to analyze the risk factors of brain injury in NICU high-risk infants.Results Compared with no brain injury group,the number of low body mass cases,FDIU cases,MV cases,prenatal risk factors,maternal infection,BDNF and 25(OH)D levels in brain injury group were higher(P<0.05).Logistic regression analysis showed that low body weight,FDIU,MV,prenatal risk factors,maternal infection,BDNF,25(OH)D were risk factors for brain injury in NICU high-risk infants(P<0.05).Conclusion Low body mass,FDIU,MV,prenatal risk factors,maternal infection,BDNF,25(OH)D were risk factors for brain injury in NICU high-risk infants.On the basis of considering the above factors,targeted interventions can be taken in clinic to help reduce the risk of brain injury.