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目的探讨引起早产儿脑损伤的高危因素,以降低其发病率,改善神经发育预后。方法对2005年8月-2007年8月本院NICU收治的130例早产儿于出生第1、3、4、7、15天及第1、3、6个月行颅脑超声检查,Ⅰ、Ⅱ级脑室内出血(IVH)为轻度脑损伤;Ⅲ、Ⅳ级IVH/脑室周围白质软化(PVL)为重度脑损伤。应用SPSS11.5统计软件对其胎龄、出生体质量、母亲有无妊娠高血压综合征、胎膜早破、分娩方式(阴道分娩、剖宫产)、患儿产前有无宫内窘迫、产时有无窒息、窒息复苏(包括气管插管或面罩加压给氧)、是否给予肺泡表面活性物质、出生后有无呼吸暂停、惊厥、低氧血症、高碳酸血症、低碳酸血症、酸中毒、有无吸氧、是否采用鼻塞持续呼吸道正压(nCPAP)或呼吸机辅助通气17个项目行Logistic回归分析。结果130例早产儿中,颅脑超声检出脑损伤88例,发生率66.7%。其中,轻度脑损伤29例(占33%)(IVHⅠ级5例,Ⅱ级24例);重度脑损伤59例(占67%)[IVHⅢ级53例,Ⅳ级1例,PVL5例(伴IVHⅠ级1例,Ⅱ级、Ⅲ级各2例)]。胎龄越小、出生体质量越低,脑损伤发生率越高;窒息复苏、出生后低氧血症及采用nCPAP或呼吸机辅助通气也是早产儿脑损伤较重要的高危因素,这些因素均可影响早产儿脑血流自主调节功能,触发或加重脑损伤。结论小胎龄、低出生体质量、窒息复苏、低氧血症及辅助通气等为早产儿脑损伤高危因素,通过影响早产儿脑血流自主调节功能,进而影响脑血流动力学参数,导致早产儿脑损伤的发生。
Objective To explore the risk factors of brain injury in premature infants to reduce the incidence and improve the prognosis of neurodevelopment. Methods 130 cases of premature infants admitted to NICU of our hospital from August 2005 to August 2007 were examined by cranial ultrasound on days 1, 3, 4, 7, 15 and 1, Grade II intraventricular hemorrhage (IVH) was mild brain injury; grade IV and IV periventricular leukomalacia (PVL) were severe brain injury. Application SPSS11.5 statistical software on its gestational age, birth weight, the mother with or without pregnancy-induced hypertension syndrome, premature rupture of membranes, mode of delivery (vaginal delivery, cesarean section), children with or without intrauterine distress, Whether there are asphyxia during birth, apnea recovery (including endotracheal intubation or mask pressure to oxygen), whether to give alveolar surfactant, whether after birth, apnea, convulsions, hypoxemia, hypercapnia, hypocapnia (NCPAP) or ventilator-assisted ventilation (n = 17) using Logistic regression analysis. Results Among 130 premature infants, 88 cases of brain injury were detected by ultrasound and the incidence was 66.7%. Among them, mild brain injury in 29 cases (33%) (IVH Ⅰ 5 cases, Ⅱ 24 cases); severe brain injury in 59 cases (67%) [IVH Ⅲ grade 53 cases, Ⅳ grade in 1 case, PVL 5 cases 1 case of IVH grade I, 2 cases of grade II, and 3 cases of grade III)]. The smaller the gestational age, the lower the birth weight, the higher the incidence of brain injury. Apnea recovery, postnatal hypoxemia and the use of nCPAP or ventilator-assisted ventilation are more important risk factors for brain injury in preterm infants, and these factors may be Affect the autonomic regulation of cerebral blood flow in preterm infants, triggering or aggravating brain injury. Conclusions The risk factors of brain injury in preterm infants, such as small gestational age, low birth weight, asphyxia resuscitation, hypoxemia and assisted ventilation, affect the cerebral hemodynamics parameters by influencing cerebral blood flow autonomic regulation in preterm infants, resulting in Occurrence of brain injury in premature infants.