低氧限光方案与早产儿视网膜病的相关研究

目的:探讨低氧限光方案对预防极低出生体重儿(VLBW I)视网膜病(Rop)的有效性、安全性。方法:将2002年10月~2005年4月广州市重症孕产妇抢救中心出生后入住该科需氧疗的VLBW I 40例,随机分为低氧限光方组(II组)及常规给氧无限光组(III组)各20例,另取近5年我科住院资料完整的VLBW I15例作为对照组(I组),对照组在出生后无需氧疗或低氧治疗时间少于5 d。全部研究对象于纠正胎龄33、34、35、36周接受4次眼底检查,根据Rop结果复查直至视网膜血管发育成熟为止,连续随访视力、眼底、眼位及客观检影、脑瘫及支气管肺发育不良的发生情况。结果:①III组发生Rop达40%,显著高于I、II组(P均<0.05),各组Rop发生时间均在34~36周,平均发病年龄为纠正胎龄35.3周。②各组Rop的发生与高危单因素的分析显示出生体重、胎龄、住院时间、败血症的发生与Rop有关,对照组(I组)Rop的发生还与1 m in Apgar评分及其血压有关(P<0.05),低氧限光组(II组)Rop的发生还与BE>-10有关。用logistic综合分析发现与Rop的发生有显著相关的因素为胎龄(P<0.05)、出生体重(P<0.05)。③其中40例随访10~16个月的资料示III组视力异常及支气管肺发育不良的发生率分别为50%、25%,显著高于I、II组(P<0.05),而脑瘫的发生率在3组间无显著差异。结论:在临床上应用低氧限光方案对预防VLBW I的Rop发生是有效和安全的,且可降低支气管肺发育不良的发生率,并不增加脑瘫的发生率。

Relationship between the programme of hypoxia - limit light and retinopathy of prematurity

Objective:To explore the efficiency and safety of hypoxia-limit light programme in avoiding the retinopathy of prematurity(ROP) of very low birth weight infants(VLBWIs).Methods: Forty VLBWIs were randomly divided into hypoxia limited light group(Group II) and routinely oxygenated group(Group III) with 20 cases in each group.Other fifteen VLBWIs who did not need any oxygen or hypoxia therapy for less than five days were considered as the control group(Group I).All VLBWIs accepted eyeground examinations at the rectified age of 33,34,35 and 36 gestational weeks.According to the results of ROP,kept these eyeground examinations up to the retinal capillaries were mature,recording the visit sight,the occurrence of brain palsy(BP) and branch-pulmorary dysplasia(BPD) and so on.Results:The occurrence of ROP in group III amounted to 40%,showing significantly higher than those in group I and group II.The time that VLBWIs suffered from ROP were between 34 to 36 gestational weeks,the average time was 35.5 gestational weeks.The birth weight,gestational age,time of hospitalization and sepsis were related to ROP.Apart from these risk facts,the occurences of ROP in group I were relative to one-minute Apgar grade and the blood pressure and that in group II to BE>-10.With logistic comprehensive analysis,only low birth weight and gestational age were found to be the major causes of ROP(P<0.05).Forty cases of these VLBWIs followed for 10~16 monthes showed that the sight abnormality and BPDs amounted to 50% and 25% respectively in group III,which were significant higher than these in group I and group II(P<0.05).But there was no significant difference in occurence of BP as a whole(P<0.05).Conclusion:The application of hypoxia-limited light programme is a valid and safety therapy.It would be able to avoid ROP and decrease the occurrence of BPD,but couldn't increase the occurence of BP.