CAJ | 학술논문

目的正确认识早产儿视网膜病变(简称ROP)的筛查标准;评价筛查标准在早产儿视网膜病变防治中的实用性、可行性、有效性;探讨建立完善的早产儿视网膜病变筛查体系,提高筛查水平.方法回顾性研究.收集2005年1月1日至2010年12月31日期间住院治疗并新生儿医师请会诊的672例早产儿.参照中华医学会制定的早产儿视网膜病变防治指南进行筛查.在早产儿生后4～6周,由有经验的眼科医师应用双目间接眼底镜对其进行定期眼底筛查.每两周行1～2次早产儿的眼底筛查,根据患儿筛查情况结果,决定进行下一步的工作.结果(1)在所筛查的672例早产儿中首检为正常视网膜者605例,发生ROP 67例,占9.97％,其中ROP Ⅰ期38只眼,ROPⅡ期60只眼,ROPⅢ期4只眼,ROPⅢ期伴plus病变(3区)16只眼,ROPⅢ期伴plus病变(2区)10只眼,ROPⅣ期2只眼,AP-ROP(进展性后部ROP)2只眼;阈值前病变20只眼,阈值病变14只眼.(2)其中接受眼底激光治疗26只眼,行玻璃体切割手术6只眼(ROP发展至Ⅳ期);其中死亡5例10只眼.(3)67例ROP患儿出生体重均低于2500 g;出生体重≤1000 g、1001～1500 g、1501～2000 g、≤2500 g的早产儿ROP的比例分别为56.76％、12.83％、5.10％、3.42％.(4)孕周小于32W,发生ROP 55例,占82.09％;孕周小于34W,发生ROP 64例,占95.52％.结论早产、低出生体重是ROP发生的高危因素;对于全身疾病严重的患儿需适当放宽筛查标准.根据不同地域,制定不同的筛查标准.孕周小于34周或出生体重小于2000g的早产儿进行ROP筛查的标准是可行的,值得推广应用.
목적 정학인식조산인시망막병변(간칭ROP)적사사표준;평개사사표준재조산인시망막병변방치중적실용성、가행성、유효성;탐토건립완선적조산인시망막병변사사체계,제고사사수평.방법 회고성연구.수집2005년1월1일지2010년12월31일기간주원치료병신생인의사청회진적672례조산인.삼조중화의학회제정적조산인시망막병변방치지남진행사사.재조산인생후4～6주,유유경험적안과의사응용쌍목간접안저경대기진행정기안저사사.매량주행1～2차조산인적안저사사,근거환인사사정황결과,결정진행하일보적공작.결과(1)재소사사적672례조산인중수검위정상시망막자605례,발생ROP 67례,점9.97％,기중ROP Ⅰ기38지안,ROPⅡ기60지안,ROPⅢ기4지안,ROPⅢ기반plus병변(3구)16지안,ROPⅢ기반plus병변(2구)10지안,ROPⅣ기2지안,AP-ROP(진전성후부ROP)2지안;역치전병변20지안,역치병변14지안.(2)기중접수안저격광치료26지안,행파리체절할수술6지안(ROP발전지Ⅳ기);기중사망5례10지안.(3)67례ROP환인출생체중균저우2500 g;출생체중≤1000 g、1001～1500 g、1501～2000 g、≤2500 g적조산인ROP적비례분별위56.76％、12.83％、5.10％、3.42％.(4)잉주소우32W,발생ROP 55례,점82.09％;잉주소우34W,발생ROP 64례,점95.52％.결론 조산、저출생체중시ROP발생적고위인소;대우전신질병엄중적환인수괄당방관사사표준.근거불동지역,제정불동적사사표준.잉주소우34주혹출생체중소우2000g적조산인진행ROP사사적표준시가행적,치득추엄응용.
Objective To describe retinopathy of prematurity(ROP)of preterm infants in Xiamen and evaluate the efficacy of applying current screening guidelines.Methods Retrospective data on preterm infants were collected who were referred by their neonatologist for ROP screening at Xiamen First Hospital between January 2005 and December 2010 according to the Screening criteria of our country.Additionally,older preterm infants considered at risk for ROP by the neonatal intensive care unite were screened.Initial examinations begin 4-6 weeks after birth or at 32 weeks postconception.Routine ophthalmologic examinations used by the indirect ophthalmoscopy and the scleral depression.All infants were followed-up until a stable retinal situation was reached.Results Retinopathy of prematurity was detected in 9.97％ of 672 neonates who had eye examinations.Including 38 eyes suffered from stage Ⅰ,60 eyes suffered from stage Ⅱ,4 eyes suffered from stage Ⅲ,16 eyes suffered from stageⅢ?with plus disease(zone 3),10 eyes suffered from stageⅢ?with plus disease(zone 2),2 eyes suffered from stage Ⅳ,2 eyes suffered from stage of AP-ROP Favorable outcome was observed in 26 infants who had undergone photocoagulation;3 infants developed retinal detachment with plus disease and performed vitretectomy.Four infants died.The occurrence rate of ROP in the infants with the birth weight ≤1000g,1001-1500g,1501-2000g,≤2500g was 56.76％,12.83％,5.10％,3.42％,respectively;the occurrence rate of ROP in the infants with the gestational age ≤32 weeks,≤34weeks was 82.09％,95.52％.Conclusions The criteria for ROP screening programs should be designed according to local conditions.In our country,screening all premature babies with a gestational age less than 34 weeks or a birth weight less than 2000g appears to be appropriate.