摘要
目的:早产儿进行体外氧化隔膜(ECMO)治疗后, 可引发颅内出血(ICH)本文研究患儿年龄对引发颅内出血风险的影响。方法:本文为回顾性定群研究,从1992-2000年间早产儿护理情况登记处的记录资料中,收集到符合试验标准的病例1524例,患儿胎龄均为小于37周,且接受体外氧化隔膜(ECMO)治疗。与ICH相关的患者年龄可定义为胎龄、出生后年龄(PNA) 和孕龄(PCA),利用多变量logistic回归分析进行数据处理,获得颅内出血和患者年龄间的关系。结果:PNA 和ICH在单因素相关分析中呈反比例关系(P=0.01), 而在多元分析中则无此关系(P=0.36)。随着PCA增长,ICH患儿数量明显下降,二者呈显著性相关:PCA小于32周的患儿,有26%患有ICH;相比之下,PCA为38 周的患儿中发病率为6%(P=0.004)。用多变量logistic 回归分析,检验ICH的独立预测因素:PCA(P= 0.005)、脓毒败血症(P=0.004)、酸中毒(P=0.004)和碳酸氢钠治疗(P=0.002)。当统计过程加入PNA的时候,则胎龄和ICH仅在多元模式中具有相关性。结论: 对于用ECMO治疗的早产婴儿,PNA不是预测ICH发生的显著性指标,而PCA则与ICH的发生具有很好的年龄相关性,可作为显著性预测指标。
Objective To determine the effect of patient age on the risk of intracranial hemorrhage (ICH) in premature neonates treated with extracorporeal membrane oxygenation (ECMO). Study design This was a retrospective cohort study of neonates of < 37 weeks' gestation treated with ECMO in the years 1992 through 2000 and reported to the Extracorporeal Life Support Organization Registry (n = 1524) . The relation between ICH and patient age, defined as gestational age, postnatal age (PNA), and postconceptional age(PCA), was determined with the use of multiple logistic regression analysis. Results PNA was inversely correlated with ICH in the univariate analysis (P =. 01) but not in the multivariate analysis (P = . 36) . PCA showed a strong univariate correlation with decreasing ICH: 26% of patients≤32 weeks' PCA developed ICH as compared with 6% of patients with PCA of 38 weeks (P = . 004). Multiple logistic regression identified as independent predictors of ICH: PCA (P = .005), sepsis (P = .004), acidosis (P = .0004), and treatment with sodium bicarbonate (P = . 002). Gestational age was correlated with ICH in the multivariate model only when PNA was included. Conclusions Postnatal age is not a strong independent predictor of ICH in premature neonates treated with ECMO. PCA is the best age-related predictor of ECMO-related ICH in premature infants.
