【摘要】 目的探讨极低出生体重早产儿视网膜病变(ROP)的检出率及危险因素。方法回顾性分析2017年4月至2019年5月在新生儿重症监护室住院的极低出生体重儿208例为研究对象。以是否发生ROP分为ROP组(98例192眼)与非ROP组(110例220眼),其中ROP组患儿根据是否需要治疗分为重症组(6例12眼)与非重症组(92例180眼)。记录极低出生体重儿的一般资料、母亲围生期情况、住院期间治疗措施及早产儿相关疾病进行单因素分析,筛选有统计学意义的单因素进行Logistic回归分析,寻找ROP的独立危险因素。结果 208例极低出生体重儿ROP的检出率为47.1%(98/208),ROP患儿中需手术干预比例为6.1%(6/98)。单因素分析发现,ROP组与非ROP组阴道分娩、胎龄、出生体重、1 min和5 min的Apgar评分、气管插管、肺表面活性物质(PS)应用、吸氧时间长、吸氧浓度≥40%、输血、新生儿呼吸窘迫综合征、支气管肺发育不良、动脉导管未闭、新生儿早发型败血症、甲状腺功能减退等差异均有统计学意义(均为P<0.05)。多因素Logistic回归分析结果显示,胎龄(OR=0.497,95%CI:0.391～0.631,P<0.001)和出生体重(OR=0.998,95%CI:0.996～1.000,P=0.046)是ROP发生的独立危险因素;重症组与非重症组胎龄与性别差异均有统计学意义(均为P<0.05)。近期转归情况显示,出院后回访68例(69.3%),其中复查至无ROP且完全血管化者53例(77.9%),复查至无ROP但未完全血管化者11例(16.2%),瘢痕形成者4例(5.9%),平均完全血管化时间为168.4 d。结论极低出生体重儿的ROP检出率较高,胎龄和出生体重是极低出生体重儿发生ROP的独立危险因素。定期眼底筛查并及时治疗对防止ROP致盲至关重要。更多还原

【Abstract】 Objective To explore the detection rate and risk factors of retinopathy of prematurity(ROP) in very low birth weight infants(VLBWI).Methods A total of 208 VLBWI admitted in the neonatal intensive care unit from April 2017 to May 2019 were analyzed retrospectively. They were divided into the ROP group(98 patients, 192 eyes) and non-ROP group(110 patients, 220 eyes) according to the occurrence of retinopathy. Infants in the ROP group were divided into the severe group(6 patients, 12 eyes) and non-severe group(92 patients, 180 eyes) according to the need for treatment. General data on the VLBWI, mothers’ perinatal conditions, treatment measures during hospitalization, and related diseases of premature infants were recorded for univariate analysis, and statistically significant single factors were screened for Logistic regression analysis to explore independent risk factors for ROP.Results Among the 208 VLBWI, 98 patients suffered ROP, accounting for 47.1%, and 6 of the 98 ROP infants needed surgical intervention, accounting for 6.1%. The single-factor analysis results showed that the differences between the ROP group and non-ROP group in vaginal delivery, gestational age, birth weight, low Apgar score after 1 minute and 5 minutes, tracheal intubation, pulmonary surfactant(PS) application, time duration of oxygen inhalation, oxygen concentration≥40%, blood transfusion, neonatal respiratory distress syndrome, bronchopulmonary dysplasia, patent ductus arteriosus, early-onset neonatal sepsis, and hypothyroidism were all statistically significant(all P<0.05). The multi-factor Logistic regression analysis results showed that the gestational age(OR=0.497, 95% CI:0.391-0.631, P<0.001) and birth weight(OR=0.998, 95% CI:0.996-1.000, P=0.046) were independent risk factors for ROP. There were statistically significant differences in the gestational age and gender between the severe group and non-severe group(all P<0.05). Short-term outcomes showed that among the follow-up 68 patients(69.3%), 53 patients(77.9%) had no ROP and complete vascularization, 11 patients(16.2%) had no ROP but incomplete vascularization, and 4 patients(5.9%) had scar formation. The average duration of complete vascularization was 168.4 days. Conclusions VLBWIs have higher ROP detection rate. The gestational age and birth weight are independent risk factors for ROP in VLBWIs and regular fundus examination and timely treatment are very important to prevent blindness caused by ROP.更多还原