目的：探讨机械通气早产儿脑室周围-脑室内出血（PVH-IVH）的临床高危因素,为早产儿PVH-IVH的防治提供依据。方法：2009年1月至2011年12月入住新生儿重症监护室且应用机械通气的205例早产儿，根据生后3～7 d床旁头颅B超检查结果分为PVH-IVH组（n=84）和无PVH-IVH组（n=121），采用单因素分析和多因素logistic回归分析调查PVH-IVH发生的高危因素。结果：单因素分析显示，胎龄<32周、出生体重<1500 g、宫内窘迫、重度窒息、自然分娩、孕期感染、胎膜早破≥8 h、机械通气≥7 d、并发呼吸机相关肺炎（VAP）等9个因素与机械通气早产儿PVH-IVH的发生有关（均P<0.05）；多因素logistic回归显示，出生体重<1500 g（OR=2.665）、宫内窘迫（OR=2.177）、重度窒息（OR=5.653）、孕期感染（OR=4.365）、VAP（OR=2.299）是机械通气早产儿PVH-IVH发生的独立危险因素（均P<0.05）。结论：极低出生体重、宫内窘迫、重度窒息、孕期感染、VAP与机械通气早产儿PVH-IVH发生密切相关，在临床工作中应高度重视这些因素，以预防PVH-IVH的发生。
Abstract
OBJECTIVE: To study risk factors for periventricular-intraventricular hemorrhage (PVH-IVH) in premature infants treated with mechanical ventilation. METHODS: A total of 205 premature infants who were admitted to the neonatal intensive care unit (NICU) and treated with mechanical ventilation between January 2009 and December 2011 were enrolled. They were classified into PVH-IVH and non-PVH-IVH groups according to the results of head ultrasonography performed at 3 to 7 days after birth. Single factor and multivariate logistic regression analysis were used to identify risk factors for PVH-IVH. RESULTS: Single factor analysis indicated 9 factors associated with the development of PVH-IVH, including a gestational age of<32 weeks, a birth weight of<1500 g, intrauterine distress, severe asphyxia, vaginal delivery, maternal perinatal infection, premature rupture of membranes (PROM) at ≥8 hours, mechanical ventilation duration of ≥7 days and ventilator-associated pneumonia (VAP) (P<0.05). Multivariate logistic regression analysis showed that a birth weight of<1500 g (OR=2.665), intrauterine distress (OR=2.177), severe asphyxia (OR=5.653), maternal perinatal infection (OR=4.365) and VAP (OR=2.299) were independent risk factors for the development of PVH-IVH (P<0.05). CONCLUSIONS: Very low birth weight, intrauterine distress, severe asphyxia, maternal perinatal infection and VAP are closely associated with an increased risk of PVH-IVH in premature infants treated with mechanical ventilation. These clinical risk factors should be given more attention in the prevention of PVH-IVH.
关键词
机械通气 /
脑室周围-脑室内出血 /
高危因素 /
早产儿
Key words
Mechanical ventilation /
Periventricular-intraventricular hemorrhage /
Risk factor /
Premature infant
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
［1］陈惠金，范秀芳，高喜容，刘晓红，吴本清，吴高强，等.6家医院147例脑损伤早产儿的多中心随访报告［J］.中国当代儿科杂志， 2009，11（3）：166-172.
［2］Aly H, Hammad TA, Essers J, Wung JT. Is mechanical ventilation associated with intraventricular hemorrhage in preterm infants?［J］. Brain Dev, 2012, 34(3): 201-205.
［3］《中华儿科杂志》编辑委员会，中华医学会儿科学分会新生儿学组. 新生儿常频机械通气常规［J］. 中华儿科杂志，2004，42（5）：356-357.
［4］劭肖梅，叶鸿瑁，丘小汕. 实用新生儿学［M］. 第4版. 北京：人民卫生出版社，2011：706-707.
［5］Department of Health and Human Services.Criteria for defning nosocom-ialpneumonia［EB/OL］.［2006-08-23］.http://www.unc.edu/depts/spice/rep-ix-3.html.
［6］姜红，宋振凤，李向红，李亮亮，刘燕，刘冬云，等.极低出生体重儿脑室周围脑室内出血高危因素分析［J］. 中国实用儿科杂志，2012，27（1）：39-41.
［7］黄志恒，孙轶，陈超.早产儿脑病的研究现状［J］. 中国当代儿科杂志，2011，13（10）：771-775.
［8］彭小明，高喜容，孙正香，胡月圆，张榕.早产儿重度脑室周围脑室内出血临床高危因素分析［J］.中国新生儿科杂志，2011,26（6）：386-388.
［9］刘敬，尹晓娟，封志纯. 早产儿脑室周围—脑室内出血研究进展［J］. 中国当代儿科杂志，2008，10（3）：435-440.
［10］Moscuzza F, Belcari F, Nardini V, Bartoli A, Domenici C, Cuttano A, et al. Correlation between placental histopathology and fetal/neonatal outcome: chorioamnionitis and funisitis are associated to intraventricular haemorrage and retinopathy of prematurity in preterm newborns［J］. Gynecol Endocrinol, 2011, 27(5): 319-323.
［11］Kasper DC, Mechtler TP, Bohm J, Petricevic L, Gleiss A, Spergser J, et al. In utero exposure to Ureaplasma spp. is associated with increased rate of bronchopulmonary dysplasia and intraventricular hemorrhage in preterm infants［J］. J Perinat Med, 2011, 39(3): 331-336.
［12］Ryckman KK, Dagle JM, Kelsey K, Momany AM, Murray J. Replication of genetic associations in the inflammation, complement, and coagulation pathways with intraventricular hemorrhage in LBW preterm neonates［J］. Pediatr Res, 2011, 70(1): 90-95.
［13］Babnik J, Stucin-Gantar I, Kornhauser-Cerar L, Sinkovec J, Wraber B, Derganc M. Intrauterine inflammation and the onset of peri-intraventricular hemorrhage in premature infants［J］. Biol Neonate, 2006, 90(2): 113-121.
［14］Sorokin Y, Romero R, Mele L, Wapner RJ, Iams JD, Dudley DJ, et al. Maternal serum interleukin-6, C-reactive protein, and matrix metalloproteinase-9 concentrations as risk factors for preterm birth <32 weeks and adverse neonatal outcomes［J］. Am J Perinatal, 2010, 27(8): 631-640.
［15］Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, et al. European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants-2010 update［J］. Neonatology, 2010, 97(4): 402-417.
［16］徐发林，别静洋. 不同原因所致早产儿的临床特征［J］.实用儿科临床杂志，2010，25（8）：582-583.
［17］Badiee Z. Intraventricular hemorrhage in very low birth weight infants. Associated risk factors in Isfahan, Iran［J］. Saudi Med J, 2007, 28(9): 1362-1366.
PDF(874 KB)
