摘要
目的分析基于新生儿转运网络(neonatal transport network,NTN)、以新生儿重症监护病房(neonatal intensive care unit,NICU)为基地的区域型早产儿视网膜病变(retinopathy of prematurity,ROP)治疗效果。方法对2008年7月至2014年12月在外院确诊为ROP后依托区域型NTN转入解放军总医院第七医学中心附属八一儿童医院治疗的406例患儿的转运、手术治疗及转归情况进行回顾性分析。采用独立样本t检验、χ^2检验及Mann-Whitney非参数检验对数据进行统计学分析。结果406例中,男性257例,女性149例;出生胎龄(29.5±1.9)周,范围为24周^+5~36周;出生体重(1 234.8±268.9)g,范围为580~2 400 g;转入时间为生后(48.9±18.5)d,范围为15~78 d;转运距离(216.5±78.6)km,范围为10~625 km;转运途中无患儿死亡。360例(88.7%)极早早产儿,335例(82.5%)极低出生体重儿。1区、2区、3区病变分别为98例(24.1%)、286例(70.4%)、22例(5.4%);1~5期病变分别为51例(12.6%)、156例(38.4%)、183例(45.1%)、12例(3.0%)、4例(1.0%);186例(45.8%)有Plus病变;252例(62.1%)达到治疗标准且接受了手术治疗,其中激光治疗165例(65.5%),抗血管内皮生长因子治疗93例(36.9%),玻璃体切除16例(6.4%),巩膜环扎2例(0.8%)。最终共有18例患儿为视网膜结构不良,其中入院时已存在视网膜脱离者16例(4期12例、5期4例),仅2例为转入时无视网膜脱离但术后病情仍进展至4期。在本院接受激光和/或抗血管内皮生长因子治疗患儿的视网膜结构不良发生率为0.9%(2/236)。而视网膜结构不良组(18例)转入时间明显晚于治愈组(234例)[80(38~270)与50(19~150)d,Z=3.387,P<0.001]。结论以NICU为基地,依托转运的区域型ROP治疗网络可使ROP患儿得到及时、有效救治。
Objective To investigate the effects of neonatal intensive care unit (NICU)-centered regional neonatal transport network (NTN) on the treatment of retinopathy of prematurity (ROP). Methods A retrospective analysis was conducted to analyze the transfer, treatment and outcomes of 406 preterm infants with ROP who were transferred to the Bayi Children's Hospital Affiliated to the Seventh Medical Center of PLA General Hospital via the NTN from July 2008 to December 2014. Independent sample t-test, Chi-square test and Mann-Whitney nonparametric test were used for statistical analysis. Results Among the 406 premature infants who were transferred to our hospital because of ROP, there were 257 males and 149 females with the gestational age of (29.5±1.9) weeks (24^+5-36 weeks) and the birth weight of (1 234.8± 268.9) g (580-2 400 g). The age at transfer was (48.9±18.5) d (15-78 d) and the transport distance was (216.5±78.6) km (10-625 km). No death was reported during the transportation. Very preterm births and very low birth weight infants (VLBWI) accounted for 88.7%(360 cases) and 82.5%(335 cases), respectively. Lesions occurred in 1, 2 and 3 zones were detected in 98 (24.1%), 286 (70.4%) and 22 (5.4%) cases, respectively. Lesions of stage 1-5 were observed in 51 (12.6%), 156 (38.4%), 183 (45.1%), 12 (3.0%) and 4 (1.0%) cases. There were 186 cases (45.8%) with Plus lesions. A total of 252 cases (62.1%) underwent surgery which were achieving treatment standards, including 165 (65.5%) undergoing laser therapy, 93 (36.9%) receiving anti-vascular endothelial growth factor (VEGF) therapy, 16 (6.4%) having vitrectomy and two (0.8%) having scleral buckling. Eighteen infants were diagnosed with retinal structural abnormalities, among which 16 had retinal detachment before admission (12 in phase 4 and four in phase 5). Two without retinal detachment on admission developed to phase 4 after surgery. The incidence of retinal structural dysplasia was 0.9%(2/236) in infants receiving laser and/or anti-VEGF therapy in our hospital.
作者
李秋平
王宗华
杨秀梅
陈海花
唐洪怡
封志纯
Li Qiuping;Wang Zonghua;Yang Xiumei;Chen Haihua;Tang Hongyi;Feng Zhichun(Neonatal Intensive Care Unit,Bayi Children's Hospital Affiliated to the Seventh Medical Center of PLA General Hospital,Beijing 100700,China;Department of Ophthalmology,the Seventh Medical Center of PLA General Hospital,Beijing 100700,China)
出处
《中华围产医学杂志》
CAS
CSCD
北大核心
2019年第9期627-632,共6页
Chinese Journal of Perinatal Medicine
基金
国家自然科学基金(81671504).
关键词
早产儿视网膜病
重症监护病房
新生儿
病人转接
治疗结果
Retinopathy of prematurity
Intensive care units, neonatal
Patient handoff
Treatment outcome
