临床儿科杂志
臨床兒科雜誌
림상인과잡지
2011年
11期
1001-1011
,共11页
陈惠金%魏克伦%周丛乐%姚裕家%杨于嘉%范秀芳%高喜容%刘晓红%钱继红%吴本清%张青梅%张小兰%吴高强
陳惠金%魏剋倫%週叢樂%姚裕傢%楊于嘉%範秀芳%高喜容%劉曉紅%錢繼紅%吳本清%張青梅%張小蘭%吳高彊
진혜금%위극륜%주총악%요유가%양우가%범수방%고희용%류효홍%전계홍%오본청%장청매%장소란%오고강
早产儿%脑室内出血%脑室周围白质软化%发病率%多中心调查%中国
早產兒%腦室內齣血%腦室週圍白質軟化%髮病率%多中心調查%中國
조산인%뇌실내출혈%뇌실주위백질연화%발병솔%다중심조사%중국
premature infants%intraventficular hemorrhage%periventricular leukomalacia%incidence%multicenter investigation%China
目的 中华医学会儿科学分会新生儿学组组织国内7个城市的10家三级甲等医院进行了早产儿脑损伤多中心协作研究.该文报告其中早产儿脑损伤发生率的调查结果.方法 2005年1月至2006年8月期间,各参加单位对所有胎龄<37周的早产儿在生后3 d内常规进行初次床边头颅B超检查,以后每隔3～7 d复查1次,直至出院.结果 9单位总脑室内出血(IVH)发生率和重度IVH发生率分别为10.8%(406/3 768)和2.4%(92/3 768),其中I级IVH 22.6%(92/406),Ⅱ级54.7%(222/406),Ⅲ级17.2%(70/406),Ⅳ级5.4%(22/406);10医院中总脑室周围白质软化(PVL)发生率和囊性PVL发生率分别为2.3%(112/4 933)和0.3%(16/4 933),其中I级PVL 85.7%(96/112),Ⅱ级12.5%(14/112),Ⅲ级1.8%(2/112).发生重度IVH的可能高危因素为阴道分娩(OR=1.874,95%CI=1.172～2.997,P<0.01)、围产期窒息(OR=1.598,95%CI=1.077～2.372,P<0.05)、机械呼吸(OR=3.988,95%CI=2.448～6.948,P<0.01)以及羊水污染(OR=2.192,95%CI=1.054～4.544,P<0.05)等.发生囊性PVL的可能高危因素为阴道分娩(OR=1.400,95%CI=1.186～1.652,P<0.001)和机械呼吸(OR=3.000,95%CI=1.015～8.864,P<0.05).结论 该调查数据基本可以客观反映中国主要大城市早产儿脑损伤发生率的情况.由于中国60%以上的人口居住在农村,受农村医疗条件的限制,早产儿IVH发生率很有可能高于目前的调查结果,尚有待进一步组织包括乡村医院的多中心调查研究.
目的 中華醫學會兒科學分會新生兒學組組織國內7箇城市的10傢三級甲等醫院進行瞭早產兒腦損傷多中心協作研究.該文報告其中早產兒腦損傷髮生率的調查結果.方法 2005年1月至2006年8月期間,各參加單位對所有胎齡<37週的早產兒在生後3 d內常規進行初次床邊頭顱B超檢查,以後每隔3～7 d複查1次,直至齣院.結果 9單位總腦室內齣血(IVH)髮生率和重度IVH髮生率分彆為10.8%(406/3 768)和2.4%(92/3 768),其中I級IVH 22.6%(92/406),Ⅱ級54.7%(222/406),Ⅲ級17.2%(70/406),Ⅳ級5.4%(22/406);10醫院中總腦室週圍白質軟化(PVL)髮生率和囊性PVL髮生率分彆為2.3%(112/4 933)和0.3%(16/4 933),其中I級PVL 85.7%(96/112),Ⅱ級12.5%(14/112),Ⅲ級1.8%(2/112).髮生重度IVH的可能高危因素為陰道分娩(OR=1.874,95%CI=1.172～2.997,P<0.01)、圍產期窒息(OR=1.598,95%CI=1.077～2.372,P<0.05)、機械呼吸(OR=3.988,95%CI=2.448～6.948,P<0.01)以及羊水汙染(OR=2.192,95%CI=1.054～4.544,P<0.05)等.髮生囊性PVL的可能高危因素為陰道分娩(OR=1.400,95%CI=1.186～1.652,P<0.001)和機械呼吸(OR=3.000,95%CI=1.015～8.864,P<0.05).結論 該調查數據基本可以客觀反映中國主要大城市早產兒腦損傷髮生率的情況.由于中國60%以上的人口居住在農村,受農村醫療條件的限製,早產兒IVH髮生率很有可能高于目前的調查結果,尚有待進一步組織包括鄉村醫院的多中心調查研究.
목적 중화의학회인과학분회신생인학조조직국내7개성시적10가삼급갑등의원진행료조산인뇌손상다중심협작연구.해문보고기중조산인뇌손상발생솔적조사결과.방법 2005년1월지2006년8월기간,각삼가단위대소유태령<37주적조산인재생후3 d내상규진행초차상변두로B초검사,이후매격3～7 d복사1차,직지출원.결과 9단위총뇌실내출혈(IVH)발생솔화중도IVH발생솔분별위10.8%(406/3 768)화2.4%(92/3 768),기중I급IVH 22.6%(92/406),Ⅱ급54.7%(222/406),Ⅲ급17.2%(70/406),Ⅳ급5.4%(22/406);10의원중총뇌실주위백질연화(PVL)발생솔화낭성PVL발생솔분별위2.3%(112/4 933)화0.3%(16/4 933),기중I급PVL 85.7%(96/112),Ⅱ급12.5%(14/112),Ⅲ급1.8%(2/112).발생중도IVH적가능고위인소위음도분면(OR=1.874,95%CI=1.172～2.997,P<0.01)、위산기질식(OR=1.598,95%CI=1.077～2.372,P<0.05)、궤계호흡(OR=3.988,95%CI=2.448～6.948,P<0.01)이급양수오염(OR=2.192,95%CI=1.054～4.544,P<0.05)등.발생낭성PVL적가능고위인소위음도분면(OR=1.400,95%CI=1.186～1.652,P<0.001)화궤계호흡(OR=3.000,95%CI=1.015～8.864,P<0.05).결론 해조사수거기본가이객관반영중국주요대성시조산인뇌손상발생솔적정황.유우중국60%이상적인구거주재농촌,수농촌의료조건적한제,조산인IVH발생솔흔유가능고우목전적조사결과,상유대진일보조직포괄향촌의원적다중심조사연구.
Objectives To investigate the incidence of brain injuri in premature infants in ten hospitals of seven large cities in China sponsored by the Subspecialty Group of Neonatology of Pediatric Society, China Medical Association. Methods All premature infants with gestational age less than 37 weeks in ten hospitals were given routine cranial ultrasound within three days of birth, and then repeated every 3-7 days till the discharge from the hospital during January 2005 to August 2006. Results Incidence of intraventricular hemorrhage (IVH) and severe IVH were 10.8% (406/3 768) and 2.4% (92/3 768) with 22.6% (92/406) for grade 1, 54.7% (222/406) for grade 2, 17.2% (70/406) for grade 3 and 5.4% (22/406) for grade 4 in nine hospitals; incidence of periventricular leukomalacia (PVL) and cystic PVL were 2.3% (112/4 933) and 0.3% (16/4 933) with 85.7% (96/112) for grade 1, 12.5% (14/112) for grade 2, and 1.8% (2/112) for grade 3 including all ten hospitals, respectively. Risk factors associated with increased severity of IVH were vaginal delivery (OR = 1.874, 95% CI = 1.172 - 2.997, P < 0.01), perinatal asphyxia (OR = 1.598, 95% CI = 1.077 - 2.372, P < 0.05), mechanical ventilation (OR = 3.988, 95% CI= 2.448 -6.948, P< 0.01), and amniotic fluid contamination (OR = 2.192, 95% CI = 1.054 - 4.544, P< 0.05). Risk factors that might result in the development of cystic PVL were vaginal delivery (OR = 1.400, 95% CI = 1.186 - 1.652, P < 0.001) and mechanical ventilation (OR = 3.000, 95% CI = 1.015 - 8.864, P < 0.05). Conclusions These data reflect basically the prevalence of brain injuriy in premature infants in major cities of China. However, more than 60% of population lives in the rural area, further multicenter investigation including the rural area is expected to be undertaken in future.
