早产儿脑损伤的影响因素研究

发布时间：2019-07-24 06:12

【摘要】：目的探讨早产儿脑损伤(BIPI)的影响因素。方法选取2014年6月—2015年12月在福建医科大学附属漳州市医院出生且立即入住新生儿监护病房(NICU)的早产儿151例。采用颅脑B超和MRI检查诊断早产儿的BIPI(包括出血性脑损伤、缺血性脑损伤)发生情况,通过查阅病历的方法收集早产儿的临床资料,采用多因素Logistic回归分析探讨早产儿发生出血性脑损伤、缺血性脑损伤的影响因素。结果 151例早产儿中,共发生BIPI 61例(40.4%),其中出血性脑损伤47例(31.1%),缺血性脑损伤33例(21.8%),出血性合并缺血性脑损伤19例(12.6%)。不同胎龄,产妇是否发生绒毛膜羊膜炎(HCA),新生儿期是否发生脓毒症、低氧窒息、代谢性酸中毒、进行机械通气早产儿的出血性脑损伤发生率比较,差异有统计学意义(P0.05);不同性别、分娩方式、出生体质量及是否多胎,产妇是否发生妊娠期糖尿病(GDM)、妊娠期高血压、孕期感染、使用地塞米松,新生儿期是否发生低血糖、高碳酸血症、低碳酸血症、合并肺部并发症早产儿的出血性脑损伤发生率比较,差异无统计学意义(P0.05)。产妇是否发生HCA,新生儿期是否发生脓毒症、低氧窒息、进行机械通气早产儿的缺血性脑损伤发生率比较,差异有统计学意义(P0.05);不同性别、胎龄、分娩方式、出生体质量及是否多胎,产妇是否发生GDM、妊娠期高血压、孕期感染、使用地塞米松,新生儿期是否发生低血糖、代谢性酸中毒、高碳酸血症、低碳酸血症、合并肺部并发症早产儿的缺血性脑损伤发生率比较,差异无统计学意义(P0.05)。多因素Logistic回归分析结果显示:胎龄,产妇是否发生HCA,新生儿期是否发生脓毒症、低氧窒息、代谢性酸中毒是早产儿发生出血性脑损伤的影响因素(P0.05);产妇是否发生HCA,新生儿期是否发生脓毒症、低氧窒息是早产儿发生缺血性脑损伤的影响因素(P0.05)。结论早产儿的BIPI发生率较高;胎龄32周,产妇发生HCA,新生儿期发生脓毒症、低氧窒息、代谢性酸中毒是其危险因素。
[Abstract]:Objective to investigate the influencing factors of (BIPI) in premature infants with brain injury. Methods from June 2014 to December 2015, 151 premature infants born in Zhangzhou Hospital affiliated to Fujian Medical University and admitted to neonatal intensive care unit (NICU) were selected. The occurrence of BIPI (including hemorrhagic brain injury, ischemic brain injury) in premature infants was diagnosed by craniocerebral B-ultrasound and MRI. The clinical data of premature infants were collected by consulting medical records, and the influencing factors of hemorrhagic brain injury and ischemic brain injury in premature infants were discussed by multivariate Logistic regression analysis. Results among 151 premature infants, 61 cases (40.4%) had BIPI, including 47 cases (31.1%) with hemorrhagic brain injury, 33 cases (21.8%) with ischemic brain injury, and 19 cases (12.6%) with hemorrhagic brain injury complicated with ischemic brain injury. At different gestational ages, there were significant differences in the incidence of hemorrhagic brain injury in premature infants with chorioamniotic meningitis (P 0.05). There were significant differences in the incidence of sepsis, hypoxia asphyxia, metabolic acidosis and hemorrhagic brain injury in neonatal infants with chorioamniotic meningitis (P 0.05). There was no significant difference in the incidence of hemorrhagic brain injury among different sex, delivery mode, birth weight and multiple births, gestational diabetes mellitus (GDM), gestational hypertension, pregnancy infection, dexamethasone use, hypoglycemia, hypercapnia, hypocapnia and pulmonary complications in premature infants with pulmonary complications (P 0.05). There was significant difference in the incidence of ischemic brain injury in premature infants with mechanical ventilation (P 0.05). Whether the parturients had sepsis and hypoxia asphyxia in neonatal period or not, the incidence of ischemic brain injury in premature infants undergoing mechanical ventilation was significantly different (P 0.05). There was no significant difference in the incidence of ischemic brain injury in premature infants with GDM, pregnancy hypertension, infection during pregnancy, dexamethasone use, hypoglycemia, metabolic acidosis, hypercapnia, hypocapnia and pulmonary complications in different sex, gestational age, mode of delivery, birth weight and multiple births (P 0.05). The results of multivariate Logistic regression analysis showed that gestational age, HCA, neonatal sepsis, hypoxia asphyxia and metabolic acidosis were the influencing factors of hemorrhagic brain injury in premature infants (P 0.05), sepsis in neonatal period of HCA, and hypoxia asphyxia were the influencing factors of ischemic brain injury in premature infants (P 0.05). Conclusion the incidence of BIPI in premature infants is high, and sepsis, hypoxia asphyxia and metabolic acidosis are the risk factors of HCA, neonatal sepsis in parturients at 32 weeks of gestational age.
【作者单位】：福建医科大学附属漳州市医院儿科;
【分类号】：R722;;R651.15

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