298例早产儿脑损伤的危险因素分析

The Risk Factors for Brain Injury in 298 Premature Infants

摘要: 目的：探讨以MRI诊断的早产儿脑损伤的危险因素。方法：收集2019年6月至2021年6月在本院出生于西北妇女儿童医院、入住本院新生儿科、胎龄 < 37周的298例早产儿的相关临床资料及头颅磁共振检查结果。以MRI诊断早产儿是否发生脑损伤，将早产儿分为脑损伤组和非脑损伤组。比较两组早产儿的产前、产时、产后因素，进行单因素分析，对单因素分析有统计学意义的因素行早产儿脑损伤独立危险因素的Logistic回归分析。结果：298例早产儿中，非脑损伤225例，脑损伤73例。两组早产儿的出生胎龄及出生体重差异均没有统计学意义(P > 0.05)。单因素分析：剖宫产、胎膜早破、使用肺泡表面活性物质、NRDS、败血症与早产儿脑损伤有统计学意义(P < 0.05)。多因素Logistics回归分析显示：新生儿呼吸窘迫综合征(OR = 3.034, 95%CI: 1.636~5.628)、胎膜早破(OR = 1.885, 95%CI: 1.010~3.516)、败血症(OR = 3.055, 95%CI: 1.312~7.114)是早产儿脑损伤的危险因素(P < 0.05)；剖宫产(OR = 0.510, 95%CI: 0.265~0.983)是早产儿脑损伤的保护因素(P < 0.05)。结论：胎膜早破、新生儿呼吸窘迫综合征、败血症是脑损伤的危险因素，剖宫产是脑损伤的保护因素。

Abstract: Objective: To explore the risk factors of preterm infants with brain injury, on the basis of MRI. Methods: The clinical data and head magnetic resonance imaging (MRI) findings of 298 preterm in-fants were collected born in Northwest Women’s and Children’s Hospital and admitted to our neo-natal unit from June 2019 to June 2021, with gestational age < 37 weeks. MRI was used to diagnose whether brain injury occurred in preterm infants, and preterm infants were divided into brain in-jury group and non-brain injury group. The prenatal, intrapartum and postnatal factors of the two groups were compared, and univariate analysis was performed, and logistic regression analysis of independent risk factors for brain injury in preterm infants was performed for factors with statisti-cal significance in univariate analysis. Results: Of the 298 preterm infants, 225 had non-brain injury and 73 had brain injury. The differences in birth gestational age and birth weight between the two groups of preterm infants were not statistically significant (P > 0.05). The results of single factor analysis showed that the differences between different gestational age, cesarean section, premature rupture of membranes, use of alveolar surface active substance, NRDS, hyperbilirubinemia, sepsis in the two groups were statistically significant (P < 0.05). Multivariate Logistic regression analysis showed that neonatal respiratory distress syndrome (OR = 3.034, 95%CI: 1.636~5.628), premature rupture of membranes (OR = 1.885, 95%CI: 1.010~3.516), and sepsis (OR = 3.055, 95%CI: 1.312~7.114) are risk factors for brain injury in premature infants (P < 0.05), cesarean delivery (OR = 0.510, 95%CI: 0.265~0.983) is a protective factor for brain injury in premature infants (P < 0.05). Conclusions: Premature rupture of membranes, neonatal respiratory distress syndrome, hyper-bilirubinemia, and sepsis are risk factors for brain injury in premature infants, cesarean delivery is a protective factor for brain injury in premature infants.