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目的探讨早产儿脑损伤的危险因素,为防治早产儿脑损伤提供依据,以改善神经发育预后。方法选择2012年8月至2014年7月本院新生儿重症监护病房收治的早产儿临床资料进行回顾性分析,采用多因素Logistic回归模型分析早产儿脑损伤的危险因素。结果 573例早产儿中诊断早产儿脑损伤76例,发生率13.3%。脑室内出血(IVH)72例,发生率12.6%,其中Ⅰ~Ⅱ级60例,Ⅲ级9例,Ⅳ级3例;脑室周围白质软化(PVL)11例(伴IVH 7例),发生率1.9%。母亲产前或产时感染(OR=1.117)、新生儿脓毒症(OR=2.284)、坏死性小肠结肠炎(OR=3.556)、窒息复苏(OR=1.841)及机械通气(OR=1.048)为早产儿脑损伤的危险因素,产前应用糖皮质激素(OR=0.721)、胎龄(OR=0.804)、促红细胞生成素(OR=0.913)为保护因素。结论小胎龄、感染/炎症、窒息缺氧及机械通气等影响脑血流因素与早产儿脑损伤的发生密切相关。
Objective To explore the risk factors of brain injury in premature infants and provide basis for prevention and treatment of brain injury in premature infants to improve the prognosis of neurological development. Methods The clinical data of premature infants admitted to neonatal intensive care unit in our hospital from August 2012 to July 2014 were retrospectively analyzed. Multivariate Logistic regression model was used to analyze the risk factors of premature infants with brain injury. Results Among 573 premature infants diagnosed premature infants with brain injury in 76 cases, the incidence rate was 13.3%. Ventricular hemorrhage (IVH) in 72 cases, the incidence rate of 12.6%, of which Ⅰ ~ Ⅱ grade in 60 cases, Ⅲ grade in 9 cases, Ⅳ grade in 3 cases; periventricular leukomalacia (PVL) in 11 cases (with IVH 7 cases), the incidence of 1.9 %. Neonatal sepsis (OR = 2.284), necrotizing enterocolitis (OR = 3.556), resuscitation asphyxia (OR = 1.841) and mechanical ventilation (OR = 1.048) Prenatal risk factors for brain injury, prenatal glucocorticoid (OR = 0.721), gestational age (OR = 0.804), erythropoietin (OR = 0.913) as a protective factor. Conclusions Factors such as gestational age, infection / inflammation, asphyxia, hypoxia and mechanical ventilation are closely related to the occurrence of brain injury in premature infants.