极低出生体质量早产儿脑室内出血相关因素分析 #br#

目的 分析极低出生体质量早产儿脑室内出血（IVH）的相关因素，以提高患儿存活率及生存质量。方法 回顾性分析天津市中心妇产科医院新生儿重症监护病房收治的421例极低出生体质量早产儿资料，包括胎龄， 性别，分娩方式，出生体质量，其母妊娠合并症（包括妊娠合并高血压、甲状腺功能异常、妊娠合并糖尿病、胎膜早破、 绒毛膜羊膜炎和产前使用糖皮质激素），早产儿围产期情况（包括早产儿是否存在5 min Apgar评分≤7分、至生后72 h 内行头颅超声检查时是否诊断为败血症、出血性疾病、动脉导管未闭以及是否使用有创机械通气等），对影响脑室内 出血及其严重程度的相关因素进行分析。结果 与非IVH组比较，IVH组胎龄≤28周、体质量≤1 000 g、顺产、生后 5 min Apgar评分≤7分、败血症史、有创机械通气治疗史者比例明显增高，而妊娠合并高血压比例则明显降低（均P＜ 0.05）。二分类Logistic回归分析显示，顺产（OR=2.727，95%CI：1.522~4.885）和生后5 min Apgar评分≤7分（OR=2.273， 95%CI：1.163~4.442）是IVH的独立危险因素。与非重度IVH组比较，重度IVH组胎龄≤28周、体质量≤1 000 g、生后 5 min Apgar 评分≤7分、患儿败血症史者比例明显增高，母产前使用糖皮质激素者比例明显降低（均P＜0.05）。结论 有效复苏、合适的分娩方式可有效降低极低出生体质量早产儿脑室内出血的发生，产前使用糖皮质激素可在一 定程度上降低重度脑室内出血的发生。

Analysis of related factors of intraventricular hemorrhage in very low birth weight premature infants

Objective To analyze the related factors of intraventricular hemorrhage (IVH) in very low birth weight premature infants and to improve the survival rate and quality of life. Methods A retrospective analysis of 421 very low birth weight premature infants admitted to the neonatal intensive care unit of Tianjin Central Hospital of Gynecology and Obstetrics from July 2017 to July 2019 was conducted, including their gestational age, gender, delivery mode, birth weight, head ultrasound result, maternal pregnancy complications (maternal pregnancy with hypertension, thyroid dysfunction, gestational diabetes mellitus, premature rupture of membranes, chorioamnionitis and the antenatal use of glucocorticoids) and perinatal conditions (whether Apgar score 5 minutes after birth was ≤ 7, and whether there was sepsis, hemorrhagic disease, patent ductus arteriosus or invasive mechanical when the ultrasound examination was conducted within 72 hours after birth). On this basis, we analyzed the related factors of intraventricular hemorrhage and its severity. Results Compared with the non-IVH group, the proportion of infants with gestational age ≤28 weeks, birth weight≤1 000 g, 5 min Apgar score after birth ≤7, history of septicemia and history of invasive mechanical ventilation were significantly higher in the IVH group, the proportion of maternal pregnancy with hypertension was significantly lower (all P<0.05). Binary Logistic regression analysis showed that 5 min Apgar score after birth≤7 (OR=2.273, 95%CI: 1.163-4.442) and vaginal delivery (OR= 2.727, 95%CI: 1.522-4.885) were the independent risk factors for intraventricular hemorrhage. Compared with the nonsevere IVH group, the proportion of infants with gestational age ≤28 weeks, birth weight≤1 000 g, 5 min Apgar score after birth ≤7, history of septicemia were higher in the severe IVH group, while the proportion of antenatal use of glucocorticoids was lower (all P＜0.05). Conclusion The effective resuscitation and appropriate delivery mode can effectively reduce the incidence of intraventricular hemorrhage in very low birth weight premature infants, and the antenatal use of glucocorticoids can reduce the occurrence of severe intraventricular hemorrhage.