目的 分析早产儿不同类型脑损伤的发生情况及影响因素。方法 收集239例早产儿的临床资料及头颅磁共振检查结果,分析产前、产时、产后因素对早产儿脑损伤的影响。结果 早产儿脑损伤的发生率为25.5%,其中出血性脑损伤占10.5%,缺血性脑损伤占10.5%,出血+缺血性脑损伤占4.6%。胎龄越小,出血性脑损伤及总脑损伤发生率越高 (P < 0.01),缺血性脑损伤及出血+缺血性脑损伤的发生率与胎龄无关 (P > 0.05)。出血性、缺血性及总脑损伤发生率均与出生体重无关 (P > 0.05)。胎龄<34周早产儿脑损伤的保护因素是经产(OR = 0.292,95%CI:0.088~0.972)和剖宫产(OR = 0.075,95%CI: 0.015~0.368);胎龄≥34周早产儿脑损伤的保护因素是剖宫产(OR = 0.296,95%CI: 0.131~0.672),危险因素是严重感染(OR = 8.176,95%CI: 1.202~55.617)。结论 在临床工作中,应尽量延长早产儿的胎龄、掌握剖宫产指征,积极有效地预防及治疗感染,以期预防或减少早产儿脑损伤的发生。
Abstract
Objective To investigate the incidence of different types of brain injury in preterm infants and their influencing factors. Methods The clinical data and head magnetic resonance imaging (MRI) findings of 239 preterm infants were collected, and the influence of antepartum, intrapartum, and postpartum factors on brain injury in preterm infants was analyzed. Results The incidence rate of brain injury in preterm infants was 25.5%; among these infants, 10.5% had hemorrhagic brain injury, 10.5% had ischemic brain injury, and 4.6% and hemorrhagic and ischemic brain injury. The infants with a lower gestational age had higher incidence rates of hemorrhagic brain injury and overall brain injury (P < 0.01). The incidence rates of ischemic brain injury and hemorrhagic and ischemic brain injury were not correlated with gestational age (P > 0.05). The incidence rates of hemorrhagic, ischemic, and overall brain injury were not correlated with birth weight (P > 0.05). Multiparity (OR = 0.292, 95%CI 0.088-0.972) and cesarean section (OR = 0.075, 95%CI 0.015-0.368) were protective factors against brain injury in infants with a gestational age of <34 weeks; cesarean section (OR = 0.296, 95%CI 0.131-0.672) was the protective factor against brain injury in infants with a gestational age of ≥34 weeks, and severe infection (OR = 8.176, 95%CI 1.202-55.617) was the risk factor. Conclusions In order to prevent or reduce the occurrence of brain injury in preterm infants. the gestational age of preterm infants should be prolonged as much as possible and the indications for cesarean section should be grasped. Infections should be prevented and if occurring should be treated actively and effectively.
关键词
脑损伤 /
回顾性研究 /
危险因素 /
多因素分析 /
早产儿
Key words
Brain injury /
Retrospective study /
Risk factor /
Multivariate analysis /
Preterm infant
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基金
合肥市科技局自主创新社会发展类专项资助项目(2013-25-9)。
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