早产儿颅内出血危险因素的meta分析

摘要

Objective To evaluate the risk factors for intracranial hemorrhage in premature infants. Methods Cochrane Library, PubMed, ScienceDirect, Chinese Academic Literature Main Database, Chinese Science and Technology Periodi-cal Database, Wanfang Periodicals and Dissertation Database were searched for articles published from January 2000 to December 2012 on the risk factors of intracranial hemorrhage in premature infants, with retrospective retrieval and manual retrieval as supplement. RavMan5.2 provided by Cochrane was used for meta-analysis. Fixed-or random-effects models were selected according to the results of heterogeneity test. Results Nine studies were conifrmed to be eligible. Odds ratio (OR) and 95%conifdence interval (CI) of the risk factors were as follows:gestation age≤32 weeks (OR=3.29, 95%CI=2.76-3.91), birth weight≤1 500g (OR=2.68, 95% CI=2.24-3.20), maternal complications (OR=1.59, 95% CI=1.23-2.06), intrauterine distress or birth asphyxia (OR=2.42, 95% CI=2.06-2.84), mechanical ventilation (OR=3.23, 95% CI=2.55-4.09), metabolic acidosis (OR=2.88, 95%CI=2.04-4.05), use of high concentration of oxygen (OR=2.98, 95%CI=1.63-5.44), prenatal use of dexametha-sone (OR=0.69, 95%CI=0.55-0.86), respiratory distress syndrome (OR=1.57, 95%CI=1.04-2.39). Those differences were all statistically signiifcant. There was no difference in caesarean section (OR=0.99, 95%CI=0.84-1.17), multiparity (OR=1.05, 95%CI=0.79-1.40) and gender (OR=1.25, 95%CI=0.97-1.59). Conclusions The risk factors for intracranial hemorrhage in premature infants are gestation age≤32 weeks, birth weight≤1 500 g, maternal complications, intrauterine distress or birth asphyxia, mechanical ventilation, metabolic acidosis, use of high concentration of oxygen, respiratory distress syndrome, but prenatal use of dexamethasone can reduce the incidence of intracranial hemorrhage in premature infants.%目的综合评价早产儿颅内出血的危险因素。方法检索Cochrane图书馆、PubMed、ScienceDirect、中国学术文献总库、万方数据库及学位论文数据库，并辅以文献追溯、手工检索等，收集2000年1月至2012年12月有关早产儿颅内出血危险因素的临床资料。对纳入的研究数据采用Cochrane协作网提供的Revman5.2进行统计分析，根据文献异质性检验结果选用固定效应模型或者随机效应模型进行meta分析。结果经过筛选，共纳入文献9篇，meta分析显示各危险因素的合并OR值及其95%CI分别为：胎龄≤32周（OR=3.29，95%CI=2.76~3.91)、出生体质量≤1500 g（OR=2.68，95%CI=2.24~3.20)、孕母有合并症（OR=1.59，95%CI=1.23~2.06）、有宫内窘迫或出生后窒息（OR=2.42，95%CI=2.06~2.84）、机械通气（OR=3.23，95%CI=2.55~4.09）、代谢性酸中毒（OR=2.88，95%CI=2.04~4.05）、使用高浓度氧（OR=2.98，95%CI=1.63~5.44）、产前使用地塞米松（OR=0.69，95%CI=0.55~0.86）、新生儿呼吸窘迫综合征（OR=1.57，95%CI=1.04~2.39），差异均有统计学意义。剖宫产（OR=0.99，95%CI=0.84~1.17）、多胎（OR=1.05，95%CI=0.79~1.40）、性别（OR=1.25，95%CI=0.97~1.59）差异无统计学意义。结论早产儿颅内出血的主要危险因素为胎龄≤32周、出生体质量≤1500 g、孕母有合并症、有宫内窘迫或出生后窒息、机械通气、代谢性酸中毒、使用高浓度氧及新生儿呼吸窘迫综合征。产前使用地塞米松可降低早产儿颅内出血发生率。