Takahashi Ritsuko, Yamada Masaaki, Takahashi Tatsuya, Ito Takeshi, Nakae Shingi, Kobayashi Yasuko, Onuma Akira
Neonatal Intensive Care Unit in Perinatal Center, Japanese Red Cross Sendai Hospital, 2-43-3, Yagiyamahonchou, Sendai 982-8501, Japan.
Early Hum Dev. 2005 Jun;81(6):545-53. doi: 10.1016/j.earlhumdev.2004.11.007.
To identify crucial factors that precipitate cerebral palsy by controlling confounding factors in logistic regression analyses.
We retrospectively investigated a cohort of all 922 infants with gestational ages of less than 34 weeks (22-33 weeks), who were admitted to our neonatal intensive care unit between 1990 and 1998. Thirty (3.7%) were diagnosed to have cerebral palsy. We analyzed the prenatal and postnatal clinical variables of the cerebral palsy cases and compared them with 150 randomly selected controls.
Risk factors for cerebral palsy identified in univariate analysis were: twin pregnancy, long-term ritodrine tocolysis, respiratory distress syndrome, air leak, surfactant administration, intermittent mandatory ventilation, high frequency oscillation, lowest PaCO2 levels, prolonged hypocarbia during the first 72 h of life, and postnatal steroid therapy. In a conditional multiple logistic model, long-term ritodrine tocolysis, prolonged hypocarbia and postnatal steroid therapy remained associated with an increased risk of cerebral palsy after adjustment for other antenatal and postnatal variables (OR [Odds Ratio] = 8.62, 95% CI [Confidence Interval], 2.18-33.97; OR = 7.81, 95% CI, 1.42-42.92; OR = 21.37, 95% CI, 2.01-227.29, respectively).
Our results suggest that long-term ritodrine tocolysis underlines the development of cerebral palsy. Further assessments of the effect of ritodrine on fetal circulation and nervous system are required. Moreover, possible alternatives to systemic postnatal steroids are needed, and carbon dioxide levels should be more strictly controlled.
通过逻辑回归分析控制混杂因素，以确定引发脑瘫的关键因素。
我们回顾性研究了1990年至1998年间入住我院新生儿重症监护病房的所有922例孕周小于34周（22 - 33周）的婴儿队列。其中30例（3.7%）被诊断为脑瘫。我们分析了脑瘫病例的产前和产后临床变量，并将其与150例随机选择的对照进行比较。
单因素分析确定的脑瘫危险因素为：双胎妊娠、长期使用利托君进行宫缩抑制、呼吸窘迫综合征、气漏、使用表面活性剂、间歇指令通气、高频振荡、最低动脉血二氧化碳分压水平、出生后72小时内持续低碳酸血症以及产后类固醇治疗。在条件多因素逻辑模型中，在对其他产前和产后变量进行调整后，长期使用利托君进行宫缩抑制、持续低碳酸血症和产后类固醇治疗仍与脑瘫风险增加相关（比值比[OR]=8.62，95%置信区间[CI]，2.18 - 33.97；OR = 7.81，95% CI，1.42 - 42.92；OR = 21.37，95% CI，2.01 - 227.29）。
我们的结果表明，长期使用利托君进行宫缩抑制是脑瘫发生的重要因素。需要进一步评估利托君对胎儿循环和神经系统的影响。此外，需要寻找产后全身性类固醇的替代方法，并且应更严格地控制二氧化碳水平。
