本文選題：早產(chǎn)兒視網(wǎng)膜病 + 視網(wǎng)膜��； 參考：《廣州醫(yī)學(xué)院》2011年碩士論文

【摘要】：目的: 了解早產(chǎn)兒視網(wǎng)膜血管化進程、早產(chǎn)兒視網(wǎng)膜病(retinopathy of prematurity,ROP)的發(fā)生發(fā)展情況以及隨訪中存在的問題,探討ROP高危患者的隨訪需求,促進良好的隨訪,減少ROP所導(dǎo)致的危害。 方法: 1.采用前瞻性研究,將2009年9月1日至2010年8月31日在廣東省內(nèi)三家婦幼保健院出生或收治的出生體重2000g早產(chǎn)兒和低體重兒納入研究,眼底檢查使用雙目間接檢眼鏡,由有足夠ROP篩查經(jīng)驗和相關(guān)知識的眼科醫(yī)生執(zhí)行。 2.依據(jù)2004年衛(wèi)生部頒布的《早產(chǎn)兒治療用氧和視網(wǎng)膜病防治指南》,首次篩查時間從生后4～6周或矯正胎齡32周開始。對于眼底檢查時無ROP病變者,每1-3周隨訪一次;低于閾值前病變者,每1-2周隨訪一次;閾值前病變者密切觀察(至少每周隨訪1至2次),并考慮激光治療;對閾值或以上病變者必須盡快給予相應(yīng)治療;無ROP的研究對象隨訪至周圍視網(wǎng)膜完全血管化(矯正胎齡42周左右);ROP病例隨訪至病變自然退行或術(shù)后病變消退并術(shù)后至少1個月。 3.研究監(jiān)測指標(biāo):記錄每次眼底檢查時間和視網(wǎng)膜血管發(fā)育狀態(tài);研究對象住院、出院期間ROP發(fā)生和視網(wǎng)膜完全血管化比例;ROP病變的分區(qū)、分期及病變進程、治療時間、治療效果和轉(zhuǎn)歸;早產(chǎn)兒視網(wǎng)膜血管化進程;篩查隨訪中存在的問題等。 4.所有數(shù)據(jù)采用參數(shù)或非參數(shù)檢驗,使用SPSS16.0進行統(tǒng)計分析,按α=0.05檢驗水準(zhǔn),P 0.05差異有統(tǒng)計學(xué)意義。 結(jié)果: 1.一般情況:①638例納入隨訪研究,失訪52例(8.2%),完成隨訪586例,其中,ROP60例(10.2%),需治療30例(5.1%),需治療的ROP平均發(fā)生在矯正胎齡38.1±2.2周(95%置信區(qū)間37.3-39.2周),無4期或5期病變發(fā)生;②隨訪時間:完成隨訪的研究對象隨訪至矯正胎齡的中位數(shù)是41.4周(范圍36.0-59.2周)。其中,自然退行的ROP隨訪至病變消退矯正胎齡的中位數(shù)為44.0周(范圍37.1-50.6周);治療的ROP隨訪至矯正胎齡中位數(shù)為45.4周(范圍40.4-59.2周)。 2. ROP病程特點:①ROP病變1至2期、2至3期、3期至手術(shù),各期進展天數(shù)的中位數(shù)分別為14.0天、10.5天、3.0天(H=30.69,P 0.01);②閾值前病變30例,其中,4例病變在閾值前期給予激光治療,余26例中有23例(88.5%)進展至閾值病變,另3例自然退行,共計27例(90.0%)需治療。 3.早產(chǎn)兒視網(wǎng)膜血管形態(tài)變化:①出院前視網(wǎng)膜完全血管化62例(11.8%),出院后視網(wǎng)膜完全血管化464例(88.2%);②視網(wǎng)膜完全血管化時矯正胎齡中位數(shù)為41.0周(范圍36.0-42.6周)。 4.隨訪中存在的主要問題:①新生兒科和眼科醫(yī)生隨訪責(zé)任不明確,出院眼底隨訪時間不具體,告知不明確;;②家長對ROP的進展情況和嚴重性認識不足,出院患者中有23.0%需電話催促復(fù)查眼底;③由于受當(dāng)?shù)蒯t(yī)院眼底篩查條件的限制,復(fù)診困難,轉(zhuǎn)運患者基本要回救治單位復(fù)診。 結(jié)論: 1.本研究ROP的發(fā)生率為10.2%,需治療率為5.1%,需要治療的時間絕大部分發(fā)生在矯正胎齡37.0-39.0周,在此期間需高度重視,以免延誤治療時機。本研究發(fā)現(xiàn)通過規(guī)范篩查、及時治療和隨訪,ROP的近期預(yù)后良好,進一步證明了早期篩查,早期診斷和治療的重要性,遠期預(yù)后需進一步隨訪研究。 2.ROP隨病變程度的加重,病變進展速度加快,間隔時間縮短,因此,一旦篩查出ROP陽性患者,必須嚴密觀察并及時篩查;閾值前病變具有高度的進展為閾值病變的可能性,為了提高治療效果,治療標(biāo)準(zhǔn)是否提前至閾值前病變尚需要進一步研究。 3.早產(chǎn)兒生后視網(wǎng)膜完全血管化時間個體差異較大,眼底隨訪必須按時進行,出院后視網(wǎng)膜完全血管化所占比例很高,仍會發(fā)生ROP,應(yīng)強調(diào)出院后隨訪。 4.建議完善隨訪制度:包括隨訪時機和方法,明確新生兒科和眼科醫(yī)生在隨訪中的職責(zé);加強對家長和社會的宣教等。
[Abstract]:Objective:
Objective to understand the progress of retinal vascularization in premature infants, the occurrence and development of retinopathy of prematurity (ROP) and the problems in follow-up, and to explore the follow-up needs of high-risk ROP patients, and to promote good follow-up and reduce the harm caused by ROP.
Method:
1. a prospective study from September 1, 2009 to August 31, 2010, will be included in the study in Guangdong Province, three maternal and child health hospital from birth or birth weight 2000g of premature and low birth weight infants, fundus by using binocular indirect ophthalmoscope, there is enough ROP screening experience and knowledge of ophthalmologists.
The use of oxygen and retinal disease prevention guide > 2. according to 2004 issued by the Ministry of health "premature treatment, first screening time from the beginning of the 4~6 postnatal week or 32 weeks corrected gestational age. The fundus examination without ROP lesions, followed every 1-3 weeks; below the threshold of precancerous lesions, followed every 1-2 weeks; close observation of disease before the threshold (at least weekly follow-up of 1 to 2 times), and consider the laser treatment; on the threshold or above lesion must be given the appropriate treatment as soon as possible; no ROP study follow-up to peripheral retinal vascularization (corrected for gestational age 42 weeks); ROP cases to the lesion or postoperative spontaneous regression lesions subsided after operation for at least 1 months.
Study on 3. indicators: the record state each fundus examination time and retinal vascular development; the research object during hospitalization, incidence of ROP and retinal vascularization ratio of discharge; ROP lesions partition, staging and progression of disease, treatment time, treatment effect and prognosis of premature infants; retinal vascularization; problems of follow-up.
4. all the data were tested by parameter or nonparametric test, and SPSS16.0 was used for statistical analysis. According to the level of alpha =0.05 test, the difference of P 0.05 was statistically significant.
Result:
1. general situation: the 638 cases included in the follow-up study, 52 cases were lost (8.2%), 586 patients completed follow-up, among them, ROP60 (10.2% cases), for treatment of 30 cases (5.1%), the average ROP treatment occurred in the corrected gestational age of 38.1 + 2.2 weeks (95% confidence interval 37.3-39.2 weeks), no 4 or 5 of the lesions; follow-up time: to complete the follow-up study were followed to the median of postmenstrual age 41.4 weeks (36.0-59.2 weeks). Among them, the natural regression of ROP were followed to the median age of postmenstrual age was 44 weeks (range 37.1-50.6 weeks); the treatment of ROP with follow-up to the corrected gestational age a median of 45.4 weeks (40.4-59.2 weeks).
2. characteristics: the course of ROP ROP lesions of 1 to 2, 2 to 3 period, 3 period to surgery, the median of each period in days were 14 days, 10.5 days, 3 days (H=30.69, P 0.01); in 30 cases, the threshold disease among them, 4 cases were given laser treatment in pre threshold the remaining 26 cases, in 23 cases (88.5%) in the other 3 cases to threshold disease, natural regression, a total of 27 cases (90%) required treatment.
3., the morphological changes of retinal blood vessels in preterm infants: (1) 62 cases (11.8%) had complete retinal vascularization before discharge, and 464 cases (88.2%) had complete retinal vascularization after discharge. (2) the median age of corrected fetal age is 41 weeks (range 36.0-42.6 weeks) after complete retinal vascularization.
4. the main problems in the follow-up of neonatal and ophthalmologist follow-up responsibility is not clear, fundus discharge follow-up time is not specific, that is not clear;; lack of parents on the progress and severity of ROP, 23% of patients do need to call the reexamination fundus; due to the local hospital screening conditions limit, referral difficult, transport patients basic treatment units going back to visit.
Conclusion:
1. in this study, the incidence of ROP was 10.2% for the treatment rate was 5.1%, the time required to cure most occurred in the corrected gestational age of 37.0-39.0 weeks, during which needs attention, so as not to delay the timing of treatment. The study found that through standardized screening, timely treatment and follow-up of ROP, the recent good prognosis, further evidence of early screening and the importance of early diagnosis and treatment, prognosis need further follow-up study.
With the exacerbation of 2.ROP lesions, lesions in speed up, interval time is shortened, therefore, once the screening ROP positive patients must be closely observed and timely screening; threshold disease is highly likely to progress to threshold disease, in order to improve the therapeutic effect, the treatment standard is to advance further study is needed before the threshold of lesions.
3. there is a great difference in the time of retinal vascularization between preterm infants. The fundus follow-up must be carried out on time. After discharge, the proportion of retinal complete vascularization is very high. ROP will still happen. We should emphasize follow-up after discharge.
4. it is suggested that the follow-up system should be perfected, including the timing and method of follow-up, the responsibilities of the newborn and the ophthalmologists in the follow-up, and the education of the parents and the society.

【學(xué)位授予單位】：廣州醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R774.1

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