【摘要】：目的：貧血是早產(chǎn)兒新生兒期常見現(xiàn)象，貧血程度不同其治療方法及預(yù)后也有差別，重度貧血不僅影響早產(chǎn)兒生長發(fā)育，甚至可危及生命。本文擬探討圍產(chǎn)期影響早產(chǎn)兒貧血程度的危險(xiǎn)因素以及防治措施。 方法：收集重慶醫(yī)科大學(xué)附屬兒童醫(yī)院2010年1月至2010年12月期間于生后24小時(shí)內(nèi)收入新生兒病房并在住院期間出現(xiàn)新生兒貧血的早產(chǎn)兒136例，按貧血程度分為輕-中度貧血組（n=87）和重度貧血組（n=49），通過單因素檢驗(yàn)和Logistic回歸對早產(chǎn)兒貧血程度的相關(guān)因素分析。 結(jié)果：單因素檢驗(yàn)，，重度貧血組胎齡、出生體重、出生時(shí)的血紅蛋白量明顯低于輕-中度貧血組，分別為31.71±2.19周vs32.76±2.13周,1657.45±433.36g vs1885.32±485.33g，148.35±19.26g/Lvs161.22±20.8g/L，差異均有統(tǒng)計(jì)學(xué)意義（P＜0.05）。重度貧血組采血量、住院時(shí)間高于輕-中度貧血組，分別為12.28±4ml/Kg vs10.05±3.34ml/Kg,30.8±16.62天vs21.43±11.81天。差異也具有顯著統(tǒng)計(jì)學(xué)意義（P＜0.05）。多因素Logistic回歸分析，與采血量＜7ml/Kg組相比，采血量7～13ml/Kg組OR值是1.575（95%CI:0.572～4.707），但差異無統(tǒng)計(jì)學(xué)意義，采血量＞13ml/Kg與采血量＜7ml/Kg組比較OR值為5.146（95%CI:1.35519～19.542）,差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)；分析顯示住院時(shí)間也是早產(chǎn)兒發(fā)生重度貧血的危險(xiǎn)因素，OR值為1.029；出生時(shí)血紅蛋白量是早產(chǎn)兒重度貧血的保護(hù)因素，OR值為0.962。 結(jié)論：早產(chǎn)兒貧血程度與胎齡、出生體重、出生時(shí)血紅蛋白量、住院時(shí)間以及采血量有關(guān)。其中出生后2周內(nèi)的采血量和住院時(shí)間是早產(chǎn)兒發(fā)生重度貧血的獨(dú)立危險(xiǎn)因素，采血量＞13ml/Kg發(fā)生重度貧血的危險(xiǎn)性是采血量＜7ml/Kg的5倍左右。適當(dāng)增加早產(chǎn)兒出生時(shí)血紅蛋白量，盡量減少醫(yī)源性失血，縮短住院時(shí)間可有效預(yù)防早產(chǎn)兒重度貧血的發(fā)生。
[Abstract]:Objective: anemia is a common phenomenon in newborns with different degrees of anemia and its treatment and prognosis are also different. Severe anemia not only affects the growth and development of premature infants, but also endangers life. This article aims to explore the perinatal risk factors affecting the anemia degree of preterm infants and the prevention and treatment measures. Methods: from January 2010 to December 2010, 136 premature infants who were admitted to the neonatal ward within 24 hours after birth and developed neonatal anemia during the period of hospitalization in the affiliated Children's Hospital of Chongqing Medical University were collected. According to the degree of anemia, the patients were divided into mild to moderate anemia group and severe anemia group. Univariate test and Logistic regression were used to analyze the related factors of anemia degree in preterm infants. Results: univariate test showed that the gestational age, birth weight and hemoglobin at birth in severe anemia group were significantly lower than those in mild to moderate anemia group (31.71 鹵2.19 weeks vs32.76 鹵2.13 weeks, 1657.45 鹵433.36 g vs1885.32 鹵485.33 g, respectively). 148.35 鹵19.26g/Lvs161.22 鹵20.8 g / L, the difference was statistically significant (P < 0. 05). The amount of blood collected in severe anemia group was higher than that in mild to moderate anemia group (12.28 鹵3.34ml / kg 鹵30.8 鹵16.62 vs21.43 鹵11.81 days, respectively). The difference was also statistically significant (P < 0.05). Multivariate Logistic regression analysis showed that the OR value of 7~13ml/Kg group was 1.575 (95%CI:0.572~4.707), but the difference was not statistically significant. The OR value was 5.146 (95%CI:1.35519~19.542) in the group of blood collection > 13ml/Kg and < 7ml/Kg (P < 0. 05). The results showed that the length of hospitalization was also the risk factor of severe anemia in premature infants, the OR value was 1.029, and the hemoglobin content at birth was the protective factor of severe anemia in premature infants, and the OR value was 0.962. Conclusion: the degree of anemia in preterm infants is related to gestational age, birth weight, hemoglobin at birth, length of hospitalization and blood collection. The blood intake and hospital stay within 2 weeks after birth were the independent risk factors for severe anemia in premature infants. The risk of severe anemia in premature infants was higher than that in 13ml/Kg, which was 5 times higher than that in 7ml/Kg. Increasing the amount of hemoglobin at birth, reducing iatrogenic blood loss and shortening the hospital stay can effectively prevent severe anemia in preterm infants.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R722.6

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