新生儿眼底病变筛查及视网膜出血的影响因素分析

目的对新生儿眼底病变进行筛查统计,并分析视网膜出血的影响因素。方法回顾性分析2013年1月至2016年12月在我院新生儿病房行眼底筛查的1558例新生儿资料。统计新生儿眼底病变发病率以及视网膜出血发病情况,对影响视网膜出血的相关因素进行分析。结果本组1558例新生儿中筛查出眼底病变患儿196例,占12.6%;类型包括视网膜出血(8.9%)、早产儿视网膜病变(1.3%)、眼底渗出(1.2%)、视网膜有髓神经纤维(0.5%)、视网膜色素沉着(0.4%)、先天性结晶样变性(0.3%)、视网膜母细胞瘤(0.1%)。单因素分析结果显示,分娩方式、多胎、宫内窘迫、机械通气是影响视网膜出血的相关因素(均为P<0.05);而性别、是否足月、出生体质量、是否子痫、是否胎膜早破、是否窒息、是否输血、是否吸氧等因素与视网膜出血的发生并无明显相关性(均为P>0.05)。多因素Logistic回归分析结果显示,阴道分娩、机械通气是视网膜出血的独立危险因素。结论新生儿眼底病变的发生率较高,其中绝大多数为视网膜出血,阴道分娩和机械通气是导致新生儿视网膜出血的独立危险因素,应针对此类新生儿群体加强观察和干预。

Analysis of neonatal fundus lesions and the factors of retinal hemorrhage

Objective　To screen the neonatal fundus lesions and analyze the occurrence probability and the factors of retinal hemorrhage.Methods　A total of 1558 newborn infants from January 2013 to December 2016 were enrolled in this study and the clinical data were retrospectively reviewed.The incidence of fundus lesions and retinal hemorrhage was analyzed，and the related factors of retinal hemorrhage were analyzed statistically.Results　Of the 1558 newborn infants，196 patients of ocular fundus lesions were screened，accounting for 12.6%.The type of fundus lesions included retinal hemorrhage（8.9%），retinopathy of prematurity（1.3%），ocular seepage（1.2%），retinal myelinated nerve fibers（0.5%），retinal pigment（0.4%），congenital crystallization degeneration（0.3%），retinoblastoma（0.1%），respectively.Univariate analysis showed that the mode of delivery，multiple births，intrauterine distress，and mechanical ventilation were the factors affecting retinal hemorrhage (all P<0.05).Variables including gender，full-term or not，birth weight，eclampsia，premature rupture of membranes，suffocation，blood transfusion，oxygen absorption，etc.were not significantly correlated with retinal hemorrhage (all P>0.05).Multivariate logistic regression analysis showed that vaginal childbirth and mechanical ventilation were the independent risk factors for retinal hemorrhage.Conclusion　The incidence of neonatal fundus lesions is high，the vast majority of which are retinal hemorrhage.Vaginal delivery and mechanical ventilation are the independent risk factors for neonatal retinal hemorrhage，and we should strengthen the observation and intervention of such newborns.