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目的 分析窒息新生儿视网膜出血发生情况及相关影响因素.方法 选取2014年6月-2016年6月住院的325例窒息新生儿,按窒息程度分为轻度窒息组(285例)和重度窒息组(40例).另选取60例新生儿为对照组.使用第二代广角数码儿童视网膜成像系统(RetCamⅡ)于生后1～5d内行眼底检查,观察新生儿出生体质量、分娩方式、出生胎龄、Apgar评分、产程急产、产程延长、妊娠期糖尿病、妊娠期高血压疾病、检查期间有无病理性黄疸及母亲孕期、分娩时情况等.结果 325例窒息患儿中,发现视乳头水肿190例(58.46％),眼底出血88例(27.08％).285例轻度窒息患儿中,视网膜出血59例(20.70％),40例重度窒息患儿中,视网膜出血29例(72.50％),二者比较差异有统计学意义(P＜0.05).多因素Logistic回归分析结果显示:窒息、宫内窘迫、胎头吸引助产、产钳助产、急产是窒息新生儿视网膜出血的影响因素(P＜0.05).共88例视网膜出血患儿,其中出血程度Ⅰ度37例(42.05％),Ⅱ度34例(38.64％),Ⅲ度17例(19.32％).新生儿视网膜出血的严重程度与窒息程度呈正相关(r=0.417,P＜0.05).胎头吸引助产、产钳、臀位经阴道自然分娩及头位经阴道自然分娩与剖宫产新生儿视网膜出血发生率相比,差异有统计学意义(P＜0.05).视网膜出血的总吸收时间为5 ～39 d.结论 窒息、宫内窘迫、胎头吸引助产、产钳助产、急产可能是影响窒息新生儿视网膜出血的因素.动态用RetCamⅡ监测窒息新生儿视网膜出血情况可能有助于窒息患儿视网膜出血的早期判断和预后,并客观指导临床治疗.“,”Objective To analyze the occunrence and related influencing factors of retinal hemorrhage in neonates with asphyxia.Methods A total of 325 hospitalized neonates with asphyxia from June 2014 to June 2016 were selected and divided into mild asphyxia group (285 neonates) and severe asphyxia group (40 neonates) according to the degree of asphyxia.Sixty neonates without asphyxia were selected as control group.RetCam Ⅱ was used for fundus examination within 1-5 days after birth.Neonatal birth weight,delivery modes,gestational age at birth,Apgar score,precipitate labor,prolonged labor,gestational diabetes mellitus,hypertensive disorder complicating pregnancy,pathologic jaundice during examination,maternal situations during pregnancy and childbirth were observed.Results Among 325 neonates with asphyxia,190 neonates (58.46％) were found with papilledema,and 88 neonates (27.08％) were found with fundus hemorrhage.Among 285 neonates with mild asphyxia,59 neonates (20.70％) were found with retinal hemorrhage;among 40 neonates with severe asphyxia,29 neonates (72.50％) were found with retinal hemorrhage,there was statistically significant difference between the two groups (P＜0.05).Muhivariate logistic regression analysis showed that asphyxia,fetal distress,vacuum extraction,forceps delivery,and precipitate labor were influencing factors of retinal hemorrhage in neonates with asphyxia (P＜0.05).A total of 88 neonates were found with retinal hemorrhage,37 neonates (42.05％) of degree Ⅰ,34 neonates (38.64％) of degree Ⅱ,and 17 neonates (19.32％) of degree Ⅲ were included.The severity of retinal hemorrhage was positively correlated with degree of asphyxia (r=0.417,P＜0.05).There was statistically significant difference in the incidence rate of retinal hemorrhage among the neonates born by vaginal delivery of vacuun extraction,forceps delivery,breech presentation,vaginal delivery of head presentation,and cesarean section (P＜0.05).The total absorption time of retinal hemorrhage was 5-39 days.Conclusion Asphyxia,fetal distress,vacuum extraction,forceps delivery,and precipitate labor may be influencing factors of retinal hemorrhage in neonates with asphyxia.Monitoring neonatal retinal hemorrhage dynamically using RetCam Ⅱ is helpful to early prediction,prognosis evaluation,and objective guidance of clinical treatment of retinal hemorrhage.