早产儿视网膜病的近期随访研究

发布时间：2018-04-16 11:02

本文选题：早产儿视网膜病 + 视网膜　；参考：《广州医学院》2011年硕士论文

【摘要】：目的: 了解早产儿视网膜血管化进程、早产儿视网膜病(retinopathy of prematurity,ROP)的发生发展情况以及随访中存在的问题,探讨ROP高危患者的随访需求,促进良好的随访,减少ROP所导致的危害。方法: 1.采用前瞻性研究,将2009年9月1日至2010年8月31日在广东省内三家妇幼保健院出生或收治的出生体重2000g早产儿和低体重儿纳入研究,眼底检查使用双目间接检眼镜,由有足够ROP筛查经验和相关知识的眼科医生执行。 2.依据2004年卫生部颁布的《早产儿治疗用氧和视网膜病防治指南》,首次筛查时间从生后4～6周或矫正胎龄32周开始。对于眼底检查时无ROP病变者,每1-3周随访一次;低于阈值前病变者,每1-2周随访一次;阈值前病变者密切观察(至少每周随访1至2次),并考虑激光治疗;对阈值或以上病变者必须尽快给予相应治疗;无ROP的研究对象随访至周围视网膜完全血管化(矫正胎龄42周左右);ROP病例随访至病变自然退行或术后病变消退并术后至少1个月。 3.研究监测指标:记录每次眼底检查时间和视网膜血管发育状态;研究对象住院、出院期间ROP发生和视网膜完全血管化比例;ROP病变的分区、分期及病变进程、治疗时间、治疗效果和转归;早产儿视网膜血管化进程;筛查随访中存在的问题等。 4.所有数据采用参数或非参数检验,使用SPSS16.0进行统计分析,按α=0.05检验水准,P 0.05差异有统计学意义。结果: 1.一般情况:①638例纳入随访研究,失访52例(8.2%),完成随访586例,其中,ROP60例(10.2%),需治疗30例(5.1%),需治疗的ROP平均发生在矫正胎龄38.1±2.2周(95%置信区间37.3-39.2周),无4期或5期病变发生;②随访时间:完成随访的研究对象随访至矫正胎龄的中位数是41.4周(范围36.0-59.2周)。其中,自然退行的ROP随访至病变消退矫正胎龄的中位数为44.0周(范围37.1-50.6周);治疗的ROP随访至矫正胎龄中位数为45.4周(范围40.4-59.2周)。 2. ROP病程特点:①ROP病变1至2期、2至3期、3期至手术,各期进展天数的中位数分别为14.0天、10.5天、3.0天(H=30.69,P 0.01);②阈值前病变30例,其中,4例病变在阈值前期给予激光治疗,余26例中有23例(88.5%)进展至阈值病变,另3例自然退行,共计27例(90.0%)需治疗。 3.早产儿视网膜血管形态变化:①出院前视网膜完全血管化62例(11.8%),出院后视网膜完全血管化464例(88.2%);②视网膜完全血管化时矫正胎龄中位数为41.0周(范围36.0-42.6周)。 4.随访中存在的主要问题:①新生儿科和眼科医生随访责任不明确,出院眼底随访时间不具体,告知不明确;;②家长对ROP的进展情况和严重性认识不足,出院患者中有23.0%需电话催促复查眼底;③由于受当地医院眼底筛查条件的限制,复诊困难,转运患者基本要回救治单位复诊。结论: 1.本研究ROP的发生率为10.2%,需治疗率为5.1%,需要治疗的时间绝大部分发生在矫正胎龄37.0-39.0周,在此期间需高度重视,以免延误治疗时机。本研究发现通过规范筛查、及时治疗和随访,ROP的近期预后良好,进一步证明了早期筛查,早期诊断和治疗的重要性,远期预后需进一步随访研究。 2.ROP随病变程度的加重,病变进展速度加快,间隔时间缩短,因此,一旦筛查出ROP阳性患者,必须严密观察并及时筛查;阈值前病变具有高度的进展为阈值病变的可能性,为了提高治疗效果,治疗标准是否提前至阈值前病变尚需要进一步研究。 3.早产儿生后视网膜完全血管化时间个体差异较大,眼底随访必须按时进行,出院后视网膜完全血管化所占比例很高,仍会发生ROP,应强调出院后随访。 4.建议完善随访制度:包括随访时机和方法,明确新生儿科和眼科医生在随访中的职责;加强对家长和社会的宣教等。
[Abstract]:Objective:
Objective to understand the progress of retinal vascularization in premature infants, the occurrence and development of retinopathy of prematurity (ROP) and the problems in follow-up, and to explore the follow-up needs of high-risk ROP patients, and to promote good follow-up and reduce the harm caused by ROP.
Method:
1. a prospective study from September 1, 2009 to August 31, 2010, will be included in the study in Guangdong Province, three maternal and child health hospital from birth or birth weight 2000g of premature and low birth weight infants, fundus by using binocular indirect ophthalmoscope, there is enough ROP screening experience and knowledge of ophthalmologists.
The use of oxygen and retinal disease prevention guide > 2. according to 2004 issued by the Ministry of health "premature treatment, first screening time from the beginning of the 4~6 postnatal week or 32 weeks corrected gestational age. The fundus examination without ROP lesions, followed every 1-3 weeks; below the threshold of precancerous lesions, followed every 1-2 weeks; close observation of disease before the threshold (at least weekly follow-up of 1 to 2 times), and consider the laser treatment; on the threshold or above lesion must be given the appropriate treatment as soon as possible; no ROP study follow-up to peripheral retinal vascularization (corrected for gestational age 42 weeks); ROP cases to the lesion or postoperative spontaneous regression lesions subsided after operation for at least 1 months.
Study on 3. indicators: the record state each fundus examination time and retinal vascular development; the research object during hospitalization, incidence of ROP and retinal vascularization ratio of discharge; ROP lesions partition, staging and progression of disease, treatment time, treatment effect and prognosis of premature infants; retinal vascularization; problems of follow-up.
4. all the data were tested by parameter or nonparametric test, and SPSS16.0 was used for statistical analysis. According to the level of alpha =0.05 test, the difference of P 0.05 was statistically significant.
Result:
1. general situation: the 638 cases included in the follow-up study, 52 cases were lost (8.2%), 586 patients completed follow-up, among them, ROP60 (10.2% cases), for treatment of 30 cases (5.1%), the average ROP treatment occurred in the corrected gestational age of 38.1 + 2.2 weeks (95% confidence interval 37.3-39.2 weeks), no 4 or 5 of the lesions; follow-up time: to complete the follow-up study were followed to the median of postmenstrual age 41.4 weeks (36.0-59.2 weeks). Among them, the natural regression of ROP were followed to the median age of postmenstrual age was 44 weeks (range 37.1-50.6 weeks); the treatment of ROP with follow-up to the corrected gestational age a median of 45.4 weeks (40.4-59.2 weeks).
2. characteristics: the course of ROP ROP lesions of 1 to 2, 2 to 3 period, 3 period to surgery, the median of each period in days were 14 days, 10.5 days, 3 days (H=30.69, P 0.01); in 30 cases, the threshold disease among them, 4 cases were given laser treatment in pre threshold the remaining 26 cases, in 23 cases (88.5%) in the other 3 cases to threshold disease, natural regression, a total of 27 cases (90%) required treatment.
3., the morphological changes of retinal blood vessels in preterm infants: (1) 62 cases (11.8%) had complete retinal vascularization before discharge, and 464 cases (88.2%) had complete retinal vascularization after discharge. (2) the median age of corrected fetal age is 41 weeks (range 36.0-42.6 weeks) after complete retinal vascularization.
4. the main problems in the follow-up of neonatal and ophthalmologist follow-up responsibility is not clear, fundus discharge follow-up time is not specific, that is not clear;; lack of parents on the progress and severity of ROP, 23% of patients do need to call the reexamination fundus; due to the local hospital screening conditions limit, referral difficult, transport patients basic treatment units going back to visit.
Conclusion:
1. in this study, the incidence of ROP was 10.2% for the treatment rate was 5.1%, the time required to cure most occurred in the corrected gestational age of 37.0-39.0 weeks, during which needs attention, so as not to delay the timing of treatment. The study found that through standardized screening, timely treatment and follow-up of ROP, the recent good prognosis, further evidence of early screening and the importance of early diagnosis and treatment, prognosis need further follow-up study.
With the exacerbation of 2.ROP lesions, lesions in speed up, interval time is shortened, therefore, once the screening ROP positive patients must be closely observed and timely screening; threshold disease is highly likely to progress to threshold disease, in order to improve the therapeutic effect, the treatment standard is to advance further study is needed before the threshold of lesions.
3. there is a great difference in the time of retinal vascularization between preterm infants. The fundus follow-up must be carried out on time. After discharge, the proportion of retinal complete vascularization is very high. ROP will still happen. We should emphasize follow-up after discharge.
4. it is suggested that the follow-up system should be perfected, including the timing and method of follow-up, the responsibilities of the newborn and the ophthalmologists in the follow-up, and the education of the parents and the society.

【学位授予单位】：广州医学院
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R774.1

【参考文献】