严重活动期早产儿视网膜病变患儿氧疗情况及相关疾病分析

doi:10.3760/cma.j.cn115909-20200414-00149

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摘要目的：分析处于严重活动期的早产儿视网膜病变（ROP）患儿氧疗情况和所患疾病的相关性。方法：病例对照研究。收集2017年11月至2019年10月在青岛市妇女儿童医院新生儿医学中心出生的早产儿，在生后4～6周或矫正胎龄32周开始对其进行眼底检查以及氧疗情况的记录，根据是否发病以及发病的严重程度分为轻症组和重症组。2组间发病情况比较采用χ2 检验，组间计量资料的比较采用 t检验或Mann-Whitne U检验。结果：共纳入符合研究条件的早产儿464例，其中眼底正常或轻度活动期ROP的轻症组426例（91.8%），严重活动期ROP的重症组38例（8.2%）。在337例接受氧疗的早产儿中，重症组的氧疗时间明显长于轻症组，差异有统计学意义（Z=-7.074，P<0.001）；吸氧浓度的比较，2组差异无统计学意义；将吸氧方式按照单种与多种方式进行比较，2组差异无统计学意义，但是重症组机械通气的使用更为频繁，差异有统计学意义（Z=4.114，P=0.043）。对所有早产儿所患疾病进行分析，发现重症组发生新生儿呼吸窘迫综合征（NRDS）、新生儿支气管肺发育不良（NBPD）的概率更多，差异有统计学意义（χ2 =14.515，P<0.001；χ2 =4.601，P=0.032）。多因素回归分析发现，氧疗时间是影响严重活动期ROP的独立危险因素（χ2 =18.127，P<0.001）。结论：更长时间的氧疗和机械通气的频繁使用增加了严重活动期ROP的发生。新生儿窒息、NRDS、NBPD在严重ROP患儿中更多见。氧疗时间、给氧方式以及吸氧浓度是发生严重的活动期ROP的危险因素。

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关键词 ： , 视网膜病变, 早产儿, 氧疗, 窒息, 呼吸窘迫综合征

Abstract： Objective: To analyze the oxygen therapy and neonatal-related diseases in severe, active retinopathy of prematurity (ROP). Methods: This was a case control study. Preterm infants born in the neonatal medical center of Qingdao Women and Children's Hospital from November 2017 to October 2019 were enrolled, and their fundus examination and oxygen therapy were recorded at 4-6 weeks after birth or 32 weeks of corrected gestational age. Patients were divided into a mild group and severe group based on the severity of the disease. A χ2 test was used to compare the incidence between the two groups, and a t test or MannWhitney U test was used to compare the measurement data between the two groups. Results: A total of 464 preterm infants were included in the study; 426 infants (91.8%) were in the mild group with normal or mildly active ROP, and 38 infants (8.2%) were in the severe group with severely active ROP. In the 337 premature infants receiving oxygen therapy, the duration of oxygen therapy in the severe group was significantly longer than that in mild group (Z=-7.074, P<0.001). There was no significant difference in oxygen concentration or oxygen inhalation mode between the two groups. However, the use of mechanical ventilation was more frequent in the severe group (Z=4.114, P=0.043). By analyzing the diseases of all premature infants, we found that the incidence of neonatal respiratory distress syndrome (NRDS), and neonatal bronchopulmonary dysplasia (NBPD) was higher in the severe group (χ2 =14.515, P<0.001; χ2 =4.601, P<0.032). Multivariate regression analysis showed that the duration of oxygen therapy was an independent risk factor (χ2 =18.127, P<0.001). Conclusions: A longer duration of oxygen therapy and frequent use of mechanical ventilation increased the incidence of severe, active ROP. Neonatal asphyxia, NRDS and NBPD were more common in severe ROP. The duration of oxygen therapy, oxygen supply mode and oxygen concentration were the risk factors for serious, active ROP.

Key words： retinal diseases preterm infants oxygen therapy asphyxia respiratory distress syndrome

收稿日期: 2020-04-14

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基金资助:

山东省医药卫生科技发展计划项目（2016WS0298）

通讯作者: 郭佃强（ORCID：0000-0003-1349-8015），Email：gdqeye@163.com

引用本文:

郭佃强张帆仝桂平段翌单若冰. 严重活动期早产儿视网膜病变患儿氧疗情况及相关疾病分析[J]. 中华眼视光学与视觉科学杂志, 2020, 22(10): 769-774. Dianqiang Guo, Fan Zhang, Guiping Tong, Yi Duan, Ruobing Shan. Analysis of Oxygen Therapy and Related Diseases in Severe Active Retinopathy of Prematurity. Chinese Journal of Optometry Ophthalmology and Visual science, 2020, 22(10): 769-774. DOI: 10.3760/cma.j.cn115909-20200414-00149

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https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20200414-00149 或 https://www.cjoovs.com/CN/Y2020/V22/I10/769

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