摘要
目的研究能够降低早产儿脑室周围-脑室内出血(periventricular-intraventricularhemorrhage,PIVH)发生率的可行性简便方案,以期减少死亡和伤残,改善早产儿预后。方法2004年1月至2005年6月对在两院住院待产、有早产可能的孕妇及其所生婴儿,使用地塞米松、Vitk1和苯巴比妥钠预防PIVH,以探讨他们对降低早产儿PIVH发生率的疗效。结果产前母亲应用单疗程地塞米松组早产儿总的PIVH发生率和重度PIVH发生率分别为54.0%和11.1%,应用两疗程地塞米松组为51.4%和12.9%,产前母亲应用Vitk1组为42.5%和5.0%,产前母亲联合应用地塞米松+Vitk1组为31.8%和2.3%,均低于对照组,分别为65.2%和18.4%。产后婴儿应用苯巴比妥钠组重度PIVH少于对照组(χ2=4.04,P=0.044),但PIVH发生率两组差异无统计学意义(χ2=15.10,P=0.004)。结论产前应用地塞米松、Vitk1和地塞米松+Vitk均能降低早产儿PIVH发生率,但以应用地塞米松+Vitk1疗效最好。产后婴儿应用苯巴比妥钠虽不能降低早产儿PIVH发生率,但可减轻出血程度及防止出血轻度向重度转化。故认为产前母亲应用地塞米松+Vitk1,产后婴儿应用苯巴比妥钠是降低早产儿PIVH发生率及减轻出血程度的可行而有效的方案。
Objective To study the feasible prophylactic proposal for the periventricular-intraventricular hemorrhage （PIVH） in preterm infants with the aim to reduce the mortality and improve the prognosis. Methods From January 2004 to June 2005, pregnant women at high risk for preterm delivery and with gestational age of less than 35 weeks and their infants were enrolled and divided into five groups randomly. Pregnant women received antenatal intramuscular or intravenously injection of vitamin K1 10 mg per day for 2 to 7 days were Group A. Group B received antenatal intramuscular or intravenously injection of dexamethasone 10 mg per day for 1 day. Group C received antenatal intramuscular or intravenously injection of dexamethasone 10 mg per day for 2 days. Group D received dexamethasone 10 mg per day for 1 or 2 days and vitamin K1 10 mg per day for 2 to 7 days. Infants in the phenobarbital group received intravenous injection of phenobarbital within 3 hours after birth for 3 to 5 days. Infants in the control group received neither phenobarbital after birth nor dexamethasone or vitamin K1 injection antenatally. Results PIVH was diagnosed in 17 of 40 （42.5%） in Group A, 34 of 63 （54.0%） in Group B, 36 of 70 （51.4%） in Group C, 14 of 44 （31.8%） in Group D, they all higher than control group （X^2 = 15.10, P=0. 004）. More infants in the control group had severe PIVH （Grade Ⅲand Ⅳ） than other groups （X^2 =9. 527, P=0. 049）. The incidence of PIVH and severe PIVH in Group B and Group C were no significant difference. Furthermore, the incidence of PIVH was no difference in phenobarbital group （60.0%） and control group （65.2%） （X^2 = 0. 361, P = 0. 548）. But the incidence of severe PIVH in phenobarbital group （5.0%） was less than control group （18. 4%） （X^2 =4.04, P=0. 044）. Conclusions The combined antenatal administration of dexamethasone and vitamin K1 can reduce the incidence of PIVH in preterm infants. Postnatal administration of phenobarbital can not decrease the incidence of PIVH, but decrease the frequency of severe PIVH.
出处
《中华围产医学杂志》
CAS
2006年第6期408-411,共4页
Chinese Journal of Perinatal Medicine
基金
首都医科大学基础-临床合作基金资助项目(03JL42)
关键词
婴儿
早产
脑出血
地塞米松
维生素K1
苯巴比妥
Infant, premature
Cerebral hemorrhage
Dexamethasone
Vitamin KI
Phenobarbital
