机械通气早产儿脑室周围-脑室内出血临床高危因素分析

Risk factors for periventricular-intraventricular hemorrhage in premature infants treated with mechanical ventilation

摘要:

目的：探讨机械通气早产儿脑室周围-脑室内出血（PVH-IVH）的临床高危因素,为早产儿PVH-IVH的防治提供依据。方法：2009年1月至2011年12月入住新生儿重症监护室且应用机械通气的205例早产儿，根据生后3～7 d床旁头颅B超检查结果分为PVH-IVH组（n=84）和无PVH-IVH组（n=121），采用单因素分析和多因素logistic回归分析调查PVH-IVH发生的高危因素。结果：单因素分析显示，胎龄<32周、出生体重<1500 g、宫内窘迫、重度窒息、自然分娩、孕期感染、胎膜早破≥8 h、机械通气≥7 d、并发呼吸机相关肺炎（VAP）等9个因素与机械通气早产儿PVH-IVH的发生有关（均P<0.05）；多因素logistic回归显示，出生体重<1500 g（OR=2.665）、宫内窘迫（OR=2.177）、重度窒息（OR=5.653）、孕期感染（OR=4.365）、VAP（OR=2.299）是机械通气早产儿PVH-IVH发生的独立危险因素（均P<0.05）。结论：极低出生体重、宫内窘迫、重度窒息、孕期感染、VAP与机械通气早产儿PVH-IVH发生密切相关，在临床工作中应高度重视这些因素，以预防PVH-IVH的发生。

Abstract:

OBJECTIVE: To study risk factors for periventricular-intraventricular hemorrhage (PVH-IVH) in premature infants treated with mechanical ventilation. METHODS: A total of 205 premature infants who were admitted to the neonatal intensive care unit (NICU) and treated with mechanical ventilation between January 2009 and December 2011 were enrolled. They were classified into PVH-IVH and non-PVH-IVH groups according to the results of head ultrasonography performed at 3 to 7 days after birth. Single factor and multivariate logistic regression analysis were used to identify risk factors for PVH-IVH. RESULTS: Single factor analysis indicated 9 factors associated with the development of PVH-IVH, including a gestational age of<32 weeks, a birth weight of<1500 g, intrauterine distress, severe asphyxia, vaginal delivery, maternal perinatal infection, premature rupture of membranes (PROM) at ≥8 hours, mechanical ventilation duration of ≥7 days and ventilator-associated pneumonia (VAP) (P<0.05). Multivariate logistic regression analysis showed that a birth weight of<1500 g (OR=2.665), intrauterine distress (OR=2.177), severe asphyxia (OR=5.653), maternal perinatal infection (OR=4.365) and VAP (OR=2.299) were independent risk factors for the development of PVH-IVH (P<0.05). CONCLUSIONS: Very low birth weight, intrauterine distress, severe asphyxia, maternal perinatal infection and VAP are closely associated with an increased risk of PVH-IVH in premature infants treated with mechanical ventilation. These clinical risk factors should be given more attention in the prevention of PVH-IVH.