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目的 探讨极低出生体重儿(VLBWI)脑室周围-脑室内出血(PVH-IVH)的高危因素。方法 回顾性对照分析2009年10月至2010年11月青岛大学医学院附属医院VLBWI117例病例,PVH-IVH39例为PVH-IVH组,按胎龄、出生体重1∶2配对的无PVH-IVH78例为对照组,对其相关因素采用SAS9.0软件进行配对条件Logistic回归分析。结果 130例VLBWI中发生PVH-IVH39例,发生率为30.00%。应用1∶2配对的条件Logistic回归分析示经阴分娩(OR=1461.699,CI7.216～296094.700,P<0.0001)、胎儿宫内窘迫(OR=95.172,CI2.213～4093.612,P=0.0006)、机械通气(OR=65.124,CI2.258～1878.432,P=0.0228)、动脉导管未闭(PDA)(OR=42.051,CI1.935～913.839,P=0.0283)、低钠血症(OR=33.415,CI0.936～1192.593,P=0.0475)、低钙血症(OR=25.175,CI1.328～477.243,P=0.0325)是VLBWI发生PVH-IVH的高危因素;产前使用激素(OR=0.061,CI0.004～0.884,P=0.0017)是避免患儿发生PVH-IVH的保护因素。结论 经阴分娩、胎儿宫内窘迫、机械通气、PDA及电解质紊乱是VLBWI发生PVH-IVH的高危因素,而产前使用激素可预防PVH-IVH的发生,因此PVH-IVH的发生是多种因素相互作用的复杂结果。在围生期工作中应当高度重视这些因素,以提高早产儿的生存质量。
Objective To investigate the risk factors of periventricular-ventricular hemorrhage (PVH-IVH) in very low birth weight infants (VLBWI). Methods A retrospective analysis of 117 cases of VLBWI in Affiliated Hospital of Medical College of Qingdao University from October 2009 to November 2010 was performed. PVH-IVH39 patients were PVH-IVH group. There were 78 cases without PVH-IVH paired according to gestational age and birth weight As the control group, SAS9.0 software was used for paired condition Logistic regression analysis. Results PVH-IVH occurred in 130 cases of VLBWI in 39 cases, the incidence was 30.00%. Logistic regression analysis with 1: 2 pairing showed that fetal distress (OR = 95.172, CI2.213 ~ 4093.612, P = 0.0006), vaginal delivery (OR = 1461.699, CI 7.216-296094.700, Mechanical ventilation (OR = 65.124, CI2.258-1878.432, P = 0.0228), PDA (OR = 42.051, CI 1.935-913.839, P = 0.0283), hyponatremia (OR = 33.415, Hypocalcemia (OR = 25.175, CI1.328 ~ 477.243, P = 0.0325) was a risk factor for PVH-IVH in VLBWI. Prenatal hormones (OR = 0.061, CI0 .004 ~ 0.884, P = 0.0017) is to prevent PVH-IVH in children with protective factors. ConclusionsPVH, IVF, mechanical ventilation, PDA and electrolyte imbalance are the risk factors of PVH-IVH in VLBWI. However, the use of hormones can prevent the occurrence of PVH-IVH. Therefore, the occurrence of PVH-IVH is caused by many factors The complex result of interaction. In the perinatal period, we should attach great importance to these factors in order to improve the quality of life of premature children.