临床儿科杂志
臨床兒科雜誌
림상인과잡지
2015年
4期
319-322
,共4页
李冰%张茜%时赞扬%程欣茹
李冰%張茜%時讚颺%程訢茹
리빙%장천%시찬양%정흔여
梗阻性脑积水%颅内出血%相关因素%早产儿
梗阻性腦積水%顱內齣血%相關因素%早產兒
경조성뇌적수%로내출혈%상관인소%조산인
obstructive hydrocephalus%intracranial hemorrhage%related factor%premature infant
目的：探讨早产儿颅内出血后继发梗阻性脑积水的相关因素。方法将2013年6月至2014年9月住院，头颅超声示严重颅内出血(Ⅲ级及Ⅳ级)的早产儿304例，按是否继发脑积水分为脑积水组(59例)和非脑积水组(185例)，分析颅内出血后继发梗阻性脑积水的相关影响因素，比较两组患儿在生后不同时间点的侧脑室增宽程度。结果单因素分析结果显示，胎龄≤32周、出生体质量<1500g、重度窒息、剖宫产、呼吸窒息综合征(RDS)、新生儿感染、心力衰竭、动脉导管未闭(PDA)、pH值≤7.2、血小板减少、凝血功能异常、Ⅲ或Ⅳ级颅内出血的比例，在脑积水与非脑积水两组之间的差异均有统计学意义(P<0.05)。多因素logistic回归分析显示，pH值≤7.2、血小板减少、凝血功能异常、胎龄≤32周、重度窒息、Ⅲ或Ⅳ级颅内出血为继发梗阻性脑积水的独立危险因素(OR：1.76~20.46，P<0.05)。出生后各时间点，脑积水组侧脑室的后角比值均大于非脑积水组，差异有统计学意义(P均<0.05)；脑积水组左侧和右侧脑室的后角比值随时间变化的差异均有统计学意义(P均=0.000)，均在第14天时逐渐增大，第28天达到高峰。结论重视颅内出血后继发梗阻性脑积水的高危因素，对严重颅内出血患儿定期行头颅超声动态监测脑室增宽情况。
目的：探討早產兒顱內齣血後繼髮梗阻性腦積水的相關因素。方法將2013年6月至2014年9月住院，頭顱超聲示嚴重顱內齣血(Ⅲ級及Ⅳ級)的早產兒304例，按是否繼髮腦積水分為腦積水組(59例)和非腦積水組(185例)，分析顱內齣血後繼髮梗阻性腦積水的相關影響因素，比較兩組患兒在生後不同時間點的側腦室增寬程度。結果單因素分析結果顯示，胎齡≤32週、齣生體質量<1500g、重度窒息、剖宮產、呼吸窒息綜閤徵(RDS)、新生兒感染、心力衰竭、動脈導管未閉(PDA)、pH值≤7.2、血小闆減少、凝血功能異常、Ⅲ或Ⅳ級顱內齣血的比例，在腦積水與非腦積水兩組之間的差異均有統計學意義(P<0.05)。多因素logistic迴歸分析顯示，pH值≤7.2、血小闆減少、凝血功能異常、胎齡≤32週、重度窒息、Ⅲ或Ⅳ級顱內齣血為繼髮梗阻性腦積水的獨立危險因素(OR：1.76~20.46，P<0.05)。齣生後各時間點，腦積水組側腦室的後角比值均大于非腦積水組，差異有統計學意義(P均<0.05)；腦積水組左側和右側腦室的後角比值隨時間變化的差異均有統計學意義(P均=0.000)，均在第14天時逐漸增大，第28天達到高峰。結論重視顱內齣血後繼髮梗阻性腦積水的高危因素，對嚴重顱內齣血患兒定期行頭顱超聲動態鑑測腦室增寬情況。
목적：탐토조산인로내출혈후계발경조성뇌적수적상관인소。방법장2013년6월지2014년9월주원，두로초성시엄중로내출혈(Ⅲ급급Ⅳ급)적조산인304례，안시부계발뇌적수분위뇌적수조(59례)화비뇌적수조(185례)，분석로내출혈후계발경조성뇌적수적상관영향인소，비교량조환인재생후불동시간점적측뇌실증관정도。결과단인소분석결과현시，태령≤32주、출생체질량<1500g、중도질식、부궁산、호흡질식종합정(RDS)、신생인감염、심력쇠갈、동맥도관미폐(PDA)、pH치≤7.2、혈소판감소、응혈공능이상、Ⅲ혹Ⅳ급로내출혈적비례，재뇌적수여비뇌적수량조지간적차이균유통계학의의(P<0.05)。다인소logistic회귀분석현시，pH치≤7.2、혈소판감소、응혈공능이상、태령≤32주、중도질식、Ⅲ혹Ⅳ급로내출혈위계발경조성뇌적수적독립위험인소(OR：1.76~20.46，P<0.05)。출생후각시간점，뇌적수조측뇌실적후각비치균대우비뇌적수조，차이유통계학의의(P균<0.05)；뇌적수조좌측화우측뇌실적후각비치수시간변화적차이균유통계학의의(P균=0.000)，균재제14천시축점증대，제28천체도고봉。결론중시로내출혈후계발경조성뇌적수적고위인소，대엄중로내출혈환인정기행두로초성동태감측뇌실증관정황。
ObjectiveTo explore the risk factors of obstructive hydrocephalus secondary to intracranial hemorrhage in premature infants.MethodsA total of 304 premature infants were selected who were diagnosed as sever intracranial hemor-rhage (grade III and IV) by cranial bedside ultrasound admitted to our hospital from Jun. 2013 to Sep. 2014. According to wheth-er the obstructive hydrocephalus was followed, all infants were divided into hydrocephalus group (n=59) and non-hydrocephalus group (n=185). The risk factors of obstructive hydrocephalus secondary to intracranial hemorrhage were analyzed and the lateral ventricle size was measured dynamically.ResultsThe univariate analysis showed the factors related with obstructive hydro-cephalus were as follows: gestational age≤32 weeks, birth weight< 1500g, severe asphyxia, cesarean section, RDS, neonatal infection, heart failure, PDA, acidosis, thrombocytopenia, coagulation abnormalities, and intracranial hemorrhage (gradeⅢ orⅣ) (allP<0.05). Multivariate logistic regression analysis showed that acidosis, thrombocytopenia, coagulation abnormalities, gesta-tional age≤ 32 weeks, severe asphyxia, intracranial hemorrhage (gradeⅢ orⅣ) were independent risk factors for obstructive hydrocephalus (OR: 1.76~20.46, allP<0.05). At each time point after birth, the ratio of posterior horn of lateral ventricle was signiifcantly higher in hydrocephalus group than that in non-hydrocephalus group (P<0.05). There were signiifcant differences in the changes of the posterior horn ratio of left or right lateral ventricle with time in hydrocephalus group (P=0.000), increasing at 14 days and reaching the peak at 28 days after birth.ConclusionsThe risk factors for obstructive hydrocephalus secondary to intracranial hemorrhage in neonates are important. Regular and dynamical monitoring of ventricle size by cranial ultrasound is needed in infants with sever intracranial hemorrhage.
