早产儿颅内出血的影响因素分析

林杨; 闵红; 周浩泉; 陈名武; 潘家华

doi:10.16766/j.cnki.issn.1674-4152.002052

早产儿颅内出血的影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002052

中国科学技术大学附属第一医院安徽省立医院儿科，安徽合肥 230001

基金项目:

安徽省重点研究与发展计划项目 1804e03020323

详细信息

通讯作者:
潘家华，E-mail：panjiahua1960@163.com

中图分类号: R722.151 R722
计量
- 文章访问数: 447
- HTML全文浏览量: 131
- PDF下载量: 10
- 被引次数: 0
出版历程
- 收稿日期: 2020-12-15
- 网络出版日期: 2022-02-16

Influencing factors analysis of intracranial hemorrhage in premature infants

Department of Pediatrics, the First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Hospital, Hefei, Anhui 230001, China

摘要

摘要: 目的颅内出血是早产儿常见的并发症, 可留下不同程度的神经系统后遗症，本文主要探讨早产儿颅内出血的高危因素，为早期干预提供理论依据。方法选取2019年1月—2020年12月中国科学技术大学附属第一医院收治的早产儿共299例，出生后24 h内入住新生儿病区，住院期间行头颅影像学检查(头颅彩超或头颅CT、磁共振)。其中颅内出血早产儿114例为观察组，采用抽签法随机选取的同期住院的非颅内出血早产儿185例为对照组。采用单因素分析和多因素logistic回归分析探讨颅内出血的危险因素。结果单因素分析显示孕母妊娠高血压疾病、孕晚期感染、胎膜早破、胎龄、出生体重、顺产、羊水污染、1 min和5 min Apgar评分、新生儿呼吸窘迫综合征(NRDS)、机械通气与早产儿颅内出血的发生有关(χ²值分别为4.376、7.205、5.042、16.194、15.982、13.320、4.859、31.988、25.855、36.436、29.262，均P < 0.05)；多因素logistic回归分析显示顺产、1 min Apgar评分、NRDS和孕晚期感染是早产儿颅内出血的独立危险因素(均P < 0.05)。结论早产儿颅内出血与孕母妊高症、孕晚期感染、胎膜早破、胎龄、出生体重、顺产、羊水污染、1 min和5 min Apgar评分、NRDS、机械通气等多种因素有关，临床工作中应综合评估，早诊断、早治疗。
- 早产儿 /
- 新生儿 /
- 颅内出血
Abstract: Objective Intracranial hemorrhage is a common complication in premature infants, which can leave different degrees of neurological sequelae. The purpose of this study was to investigate the high risk factors of intracranial hemorrhage in premature infants and provide theoretical basis for early intervention. Methods A total of 299 preterm infants who were admitted to the Neonatal Intensive Care Unit (NICU) of the First Affiliated Hospital of University of Science and Technology of China during January 2019 and December 2020. Total 114 preterm infants with intracranial hemorrhage were selected as study group, and other 185 premature infants without intracranial hemorrhage at the same period were selected as control group. Single factor and multivariate logistic regression analysis were used to identify risk factors for intracranial hemorrhage. Results Single factor analysis indicated pregnancy induced hypertension, late gestation infection, premature rupture of membranes, gestational age, birth weight, vaginal delivery, amniotic fluid pollution, 1 minute Apgar score, 5 minute Apgar score, NRDS (neonatal respiratory distress syndrome) and mechanical ventilation associated with the development of intracranial hemorrhage in preterm neonates (the chi square values were 4.376, 7.205, 5.042, 16.194, 15.982, 13.320, 4.859, 31.988, 25.855, 36.436, 29.262, all P < 0.05). Multivariate logistic regression analysis showed vaginal delivery, 1 minute Apgar score and NRDS were independent risk factors for intracranial hemorrhage (all P < 0.05). Conclusion Intracranial hemorrhage in premature infants is related to many factors, such as pregnancy induced hypertension, late gestation infection, premature rupture of membranes, gestational age, birth weight, vaginal delivery, amniotic fluid pollution, 1 minute Apgar score, 5 minute Apgar score, NRDS and mechanical ventilation, so comprehensive evaluation, early diagnosis and early treatment should be carried out in clinical work.
- Preterm infants /
- Newborn /
- Intracranial hemorrhage

HTML全文

表 1 2组早产儿性别、孕母年龄、APTT、Hb比较

组别	例数	性别(男/女, 例)	孕母年龄(x ±s，岁)	APTT (x ±s，s)	Hb (x ±s，g/L)
观察组	114	62/52	30.96±4.64	68.14±17.44	169.02±25.22
对照组	185	101/84	30.43±4.95	65.26±14.88	173.78±25.35
统计量		0.001^a	0.920^b	1.519^b	1.582^b
P值		0.972	0.359	0.130	0.115
注：^a为χ²值，^b为t值。

下载: 导出CSV

表 2 2组早产儿颅内出血危险因素的单因素分析 [例(%)]

组别	例数	妊娠高血压疾病	孕母糖尿病	孕母甲减	孕晚期感染	双胎/多胎	胎膜早破≥18 h	胎龄<32周	出生体重<1 500 g
观察组	114	23(20.2)	27(23.7)	10(9.6)	9(7.9)	28(24.6)	30(26.3)	41(36.0)	40(35.1)
对照组	185	21(12.8)	28(17.8)	22(13.5)	3(1.6)	38(20.5)	29(15.7)	29(15.7)	28(15.1)
χ²值		4.376	3.434	0.718	7.205	0.663	5.042	16.194	15.982
P值		0.036	0.064	0.397	0.007	0.416	0.025	< 0.001	< 0.001

组别	例数	宫内窘迫	分娩方式(顺产)	胎盘异常	羊水污染	1 min Apgar评分≤7分	5 min Apgar评分≤7分	低血糖	NRDS	机械通气
观察组	114	19(16.7)	41(36.0)	8(7.0)	17(14.9)	57(50.0)	35(30.7)	9(8.6)	52(45.6)	63(55.3)
对照组	185	26(14.1)	32(17.3)	27(14.6)	13(7.0)	35(18.9)	15(8.1)	25(13.5)	26(14.1)	45(24.3)
χ²值		0.377	13.320	3.918	4.859	31.988	25.855	2.210	36.436	29.262
P值		0.539	< 0.001	0.063	0.028	< 0.001	< 0.001	0.137	< 0.001	< 0.001

下载: 导出CSV

表 3 早产儿颅内出血影响因素的logistic回归分析

变量	B	SE	Wald χ²	P值	OR(95% CI)
妊娠高血压疾病	-0.200	0.409	0.238	0.626	0.819(0.367~1.827)
胎膜早破≥18 h	-0.362	0.362	1.005	0.316	0.696(0.343~1.414)
胎龄 < 32周	0.914	0.551	2.753	0.097	2.494(0.847~7.338)
出生体重 < 1 500 g	-0.329	0.492	0.449	0.503	0.719(0.274~1.885)
分娩方式(顺)	-0.738	0.339	4.751	0.029	0.478(0.246~0.928)
羊水污染	-0.452	0.441	1.051	0.305	0.637(0.268~1.509)
1 min Apgar评分≤7分	-0.760	0.351	4.693	0.030	0.468(0.235~0.930)
5 min Apgar评分≤7分	-0.790	0.453	3.033	0.082	0.454(0.187~1.104)
NRDS	-1.032	0.437	5.586	0.018	0.356(0.151~0.838)
机械通气	-0.335	0.417	0.645	0.422	0.716(0.316~1.619)
孕晚期感染	-2.469	0.758	10.608	0.001	0.085(0.019~0.374)
注：变量赋值方法如下，1=是，2=否。

下载: 导出CSV

参考文献(21)

[1]	HORTENSIUS L M, DIJKSHOORN A B C, ECURY-GOOSSEN G M, et al. Neurodevelopmental consequences of preterm isolated cerebellar hemorrhage: A systematic review[J]. PEDS, 2018, 142(5): e20180609. doi: 10.1542/peds.2018-0609
[2]	李丹, 潘家华, 潘晖. 616例早产儿视网膜病变筛查分析[J]. 中华全科医学, 2018, 16(11): 1822-1825. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201811017.htm
[3]	KONG X, XU F, WU R, et al. Neonatal mortality and morbidity among infants between 24 to 31 complete weeks: A multicenter survey in China from 2013 to 2014[J]. BMC Pediatr, 2016, 16(1): 174. doi: 10.1186/s12887-016-0716-5
[4]	张健, 刘光辉, 赵钰玮, 等. 安徽省住院早产儿脑损伤多中心流行病学调查[J]. 中国当代儿科杂志, 2019, 21(2): 114-119. https://www.cnki.com.cn/Article/CJFDTOTAL-DDKZ201902002.htm
[5]	LEE J, ROMERO R, KIM S M, et al. A new antimicrobial combination prolongs the latency period, reduces acute histologic chorioamnionitis and funisitis, and improves neonatal outcomes in preterm PROM[J]. J Matern Fetal Neo M, 2016, 29(5): 707-720. doi: 10.3109/14767058.2015.1020293
[6]	许仁美, 柏永明, 童武华. 妊娠合并急性胰腺炎对母婴结局的影响[J]. 中国基层医药, 2019, 26(24): 2976-2979. doi: 10.3760/cma.j.issn.1008-6706.2019.24.009
[7]	HUANG J L, MENG J J, CHOONARA I, et al. Antenatal infection and intraventricular hemorrhage in preterm infants: A meta-analysis[J]. Medicine(Baltimore), 2019, 98(31): e16665. http://journals.lww.com/md-journal/subjects/Pediatrics/Fulltext/2019/08020/Antenatal_infection_and_intraventricular.38.aspx
[8]	朱亚君. 早产儿颅内出血的相关因素分析及临床结局[J]. 临床合理用药杂志, 2019, 12(7): 34-35, 37. https://www.cnki.com.cn/Article/CJFDTOTAL-PLHY201907017.htm
[9]	沈莉荣, 杨祖铭, 杨晓路, 等. 妊娠高血压综合征与极低、超低出生体质量儿的关系[J]. 实用临床医药杂志, 2018, 22(22): 65-67. doi: 10.7619/jcmp.201822021
[10]	BOTKIN N D, TUROVA V L, KOVTANYUK A E, et al. Extended model of impaired cerebral autoregulation in preterm infants: Heuristic feedback control[J]. Math Biosci Eng, 2019, 16(4): 2334-2352. doi: 10.3934/mbe.2019117
[11]	HANDLEY S C, PASSARELLA M, LEE H C, et al. Incidence trends and risk factor variation in severe intraventricular hemorrhage across a population based cohort[J]. J Pediatr, 2018, 200: 24-29. doi: 10.1016/j.jpeds.2018.04.020
[12]	SZPECHT D, GADZINOWSKI J, SEREMAK-MROZIKIEWICZ A, et al. Role of endothelial nitric oxide synthase and endothelin-1 polymorphism genes with the pathogenesis of intraventricular hemorrhage in preterm infants[J]. Sci Rep, 2017, 7: 42541. doi: 10.1038/srep42541
[13]	CHENG X R, XIA P G, SHI Z Y, et al. Increased risk of intracranial hemorrhage in preterm infants with OPRM1 gene A118G polymorphism[J]. Ann Transl Med, 2019, 7(18): 478. doi: 10.21037/atm.2019.08.53
[14]	TORRES-CUEVAS I, CORRAL-DEBRINSKI M, GRESSENS P. Brain oxidative damage in murine models of neonatal hypoxia/ischemia and reoxygenation[J]. Free Radic Biol Med, 2019, 142: 3-15. doi: 10.1016/j.freeradbiomed.2019.06.011
[15]	VESOULIS A Z, BANK L R, LAKE D, et al. Early hypoxemia burden is strongly associated with severe intracranial hemorrhage in preterm infants[J]. J Perinatol, 2019, 39(1): 48-53. doi: 10.1038/s41372-018-0236-2
[16]	TUROVA V, SIDORENKO I, ECKARDT L, et al. Machine learning models for identifying preterm infants at risk of cerebral hemorrhage[J]. PLoS One, 2020, 15(1): e0227419. doi: 10.1371/journal.pone.0227419
[17]	中国新生儿重症监护室协作性质量改进研究协作组. 极低和超低出生体重儿重度脑室内出血发生情况及其影响因素多中心研究[J]. 中华儿科杂志, 2019, 57(4): 258-264. doi: 10.3760/cma.j.issn.0578-1310.2019.04.006
[18]	EGWU C C, OGALA W N, FAROUK Z L, et al. Factors associated with intraventricular hemorrhage among preterm neonates in Aminu Kano teaching hospital[J]. Niger J Clin Pract, 2019, 22(3): 298-304.
[19]	梁如佳, 刘芳, 付晶, 等. 早产儿颅内出血592例高危因素分析[J]. 解放军医药杂志, 2018, 30(2): 46-49. doi: 10.3969/j.issn.2095-140X.2018.02.013
[20]	HOCHART A, NUYTTEN A, PIERACHE A, et al. Hemostatic profile of infants with spontaneous prematurity: Can we predict intraventricular hemorrhage development?[J]. Ital J Pediatr, 2019, 45(1): 113. doi: 10.1186/s13052-019-0709-8
[21]	孔德瑞. 不同输血方案对贫血早产儿治疗转归及神经发育的影响[J]. 河北医药, 2019, 41(20): 3069-3072, 3077. doi: 10.3969/j.issn.1002-7386.2019.20.005