单胎和多胎早产儿视网膜病变发生率比较及相关因素分析

摘要

背景 早产儿视网膜病变(ROP)是儿童盲的主要原因之一,了解ROP的诱发因素,对ROP进行筛查和早期治疗是儿童盲防治的主要任务. 目的 通过对单胎和多胎早产儿ROP的筛查,分析影响ROP发生率的相关因素.方法 收集2012年在苏州市立医院产科出生、胎龄≤34周或出生体质量≤2 000 g的早产儿或低体质量儿504例,包括单胎儿357例,多胎儿147例(其中双胎126例,三胎21例),用RetCamⅡ进行系统的ROP筛查,并跟踪和随访,比较单胎儿和多胎儿间ROP发生率的差异以及诱导ROP发生的相关影响因素. 结果 504例早产儿或低体质量儿中检出ROP患儿66例,占13.10％,其中357例单胎儿中检出ROP患儿39例,占10.92％,147例多胎儿中检出ROP患儿27例,占18.37％,多胎儿ROP的发生率高于单胎儿,差异有统计学意义(x2=5.069,P=0.024),多胎儿发生ROP的危险性高于单胎儿(OR=1.835).接受筛查的单胎儿中有吸氧史者150例,占42.02％,平均吸氧时间为5.71 d;接受筛查的多胎儿中有吸氧史者86例,占58.50％,平均吸氧时间为9.42d.结论 胎龄小、出生体质量轻和过度吸氧的早产儿ROP的发生率高;相同条件下,多胎儿ROP的发生率和危险性均明显高于单胎儿.%Background Retinopathy of prematurity (ROP) is one of major causes of childhood blindness.Early screening and treatment of ROP is necessary.Objective This study was to analyze the incidence of ROP in single and multiple premature infants and related factors.Methods This study was approved by Ethic Committee of Suzhou Municipal Hospital,and oral informed consent was obtained from the parents of the infants before any medical examinations.Five hundred and four fetus with the gestational age of ≤34 weeks or birth weight of ≤ 2 000 g were collected in Suzhou Municipal Hospital,of whom 357 infants were single fetus birth and 147 infants were multiple fetus,including 26 twins and 21 three fetus birth.The fundus were examined by RetCam Ⅱ equipment and ROP was determined based on the fundus findings and history of birth.ROP incidences between the single fetus and multiple fetus were compared,and the inducing factors were analyzed.Results Sixty-six infants were ROP in all 504 fetus,with the incidence of 13.10％.The incidence of ROP in the single fetal group was 10.92％ (39/357),which was significantly higher than 18.37％ (27/147) in the multifetal group (x2=5.069,P=0.024),and risk of ROP in the multifetal group was higher than that in the single fetal group (OR =1.835).The oxygen inhalation rate was 42.02％ (150/357) and the oxygen inhalation duration was 5.71 days in the single fetal group,and that in the multifetal group was 58.50％ (86/147) and 9.42 days,respectively.Conclusions Incidence and risk of ROP in the multifetal infants are higher than those in the single fetal infants,and low-birth-weight,less gestational weeks and excess oxygen inhalation are influence factors.