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目的探讨早产儿脑室周围白质软化(PVL)发生的危险因素。方法选取2007年1月至2008年6月在我院新生儿重症监护病房住院的早产低出生体重儿,生后1、3、7、14 d及28d行头颅B超检查,脑室周围有囊腔形成者为PVL组,无囊腔者为对照组。对23种产前及生后可能与PVL有关的因素进行分析,并将有意义的变量进行logistic回归。结果 PVL组21例,对照组48例。PVL组平均胎龄(30.6±2.0)周,明显低于对照组(31.9±2.1)周(P<0.05),生后6 h内第一次血气pH值亦明显低于对照组(7.20±0.08比7.25±0.06,P<0.05);颅内出血患儿PVL发生率70.0%(7/10)明显高于非颅内出血组23.7%(14/59)(P<0.05),机械通气患儿PVL发生率58.3%(7/12)亦明显高于非机械通气组24.6%(14/57)(P<0.05)。多因素Logistic回归分析显示,生后6 h内第一次血气pH值降低(OR=4.395,95%CI 0～0.537)和颅内出血(OR=4.741, 95%CI 1.188～26.644)是PVL的危险因素(P<0.05)。结论生后6 h内第一次血气pH值降低和颅内出血是发生PVL的主要危险因素,减少酸中毒和颅内出血对降低PVL的发生率很有意义。
Objective To investigate the risk factors of periventricular leukomalacia (PVL) in preterm infants. Methods Preterm low birth weight infants hospitalized in neonatal intensive care unit in our hospital from January 2007 to June 2008 were selected and examined by cranial ultrasonography at 1, 3, 7, 14 and 28 days after birth. The formation of PVL group, no cysts were the control group. 23 possible prenatal and postnatal PVL-related factors were analyzed, and significant variables were logistic regression. Results PVL group 21 cases, control group 48 cases. The average gestational age of PVL group (30.6 ± 2.0) weeks was significantly lower than that of control group (31.9 ± 2.1) weeks (P <0.05), and the first blood gas pH value within 6 hours after birth was also significantly lower than that of control group (7.20 ± 0.08 P <0.05). The incidence of PVL in children with intracranial hemorrhage was 70.0% (7/10), significantly higher than that in non-intracranial hemorrhage (23.7%, 14/59) (P <0.05) The rate of 58.3% (7/12) was also significantly higher than that of non-mechanical ventilation group (24.6%, 14/57) (P <0.05). Multivariate logistic regression analysis showed that the first decrease of blood gas pH (OR = 4.395,95% CI 0-0.537) and intracranial hemorrhage (OR = 4.741, 95% CI 1.188-26.644) within 6 hours after birth were the risk of PVL Factor (P <0.05). Conclusions The first decrease of pH value and intracranial hemorrhage within 6 hours after birth are the main risk factors of PVL. Reducing acidosis and intracranial hemorrhage is meaningful to reduce the incidence of PVL.