早产儿支气管肺发育不良发病影响因素分析
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摘要
目的:分析早产儿支气管肺发育不良(BPD)发病影响因素。方法:新生儿科胎龄<37周且住院时间≥28 d的早产儿164例,根据出生后持续用氧≥28 d诊断为BPD,164例早产儿分为BPD组(根据病情分为轻度及中重度BPD组)和非BPD组,分析不同胎龄、体质量早产儿BPD发生率,比较BPD组患儿及非BPD组早产儿、轻度及中重度BPD患儿的一般资料、围产期资料及治疗资料等,将差异有统计学意义的指标进行多因素Lo-gistic回归分析,观察患儿发生BPD的影响因素。结果:确诊BPD 54例早产儿中,胎龄<32周早产儿比例为85. 18%,体质量<1 500 g的早产儿比例为66. 67%; BPD组患儿胎龄、体质量低于非BPD组,试管婴儿、5 minApgar评分<8分、发生呼吸窘迫综合征(RDS)比例、肺部感染、肺出血、肺泡表面活性物质(PS)使用、无创通气、有创通气早产儿比例及输血量高于于非BPD组,差异有统计学意义(P <0. 05); Logistic回归分析显示,合并RDS、有创通气≥7 d为发生BPD的独立危险因素;轻度BPD组患儿胎膜早破史比例、败血症比例、输血次数、输血量、机械通气时间低于中重度BPD组(P <0. 05)。结论:胎龄32周以下、体质量<1 500 g的早产儿BPD的发生率较高,合并RDS、有创通气≥7 d为发生BPD的独立危险因素。
Objective: To investigate the risk factors of bronchopulmonary dysplasia( BPD) in preterm infants. Methods: The clinical data of premature infants with gestational age < 37 weeks and stay longer than 28 days in Pediatrics Department were analyzed retrospectively. According to the continuous use of oxygen ≥28 days after birth as standard,the 164 infants were divided into mild BPD group,moderate and severe BPD group according to the grading standard as well as non-BPD group. Incidence rate of premature infants BPD were analyzed from gestational age and body mass; comparing general information,perinatal period data and treatment data of premature infants from BPD group and non-BPD groups,as well as the three BPD groups; significant indexes were to be analyzed by multifactors Logistic regression analysis to detect risk factors of BPD incidence. Results: Premature infants with gestational age less than 32 weeks accounted for 85. 18% out of 54 diagnosed cases,and body mass less than 1500 g infants accounted for 666. 67%. The gestational age and body mass of BPD group infants were lower than non-BPD group; tube baby,5 min Apgar score < 8,RDS proportion,pulmonary infection,pulmonary hemorrhage,PS utilizing,NIPPV,IPPV premature infants proportion and blood transfusion volume were all higher than non-BPD group,differences were statistical significant( P < 0. 05). Logistic regression analysis showed that combined RDS and IPPV≥ 7 days were independent risk factors of BPD; There were significant differences in the history of premature rupture of membranes,septicemia,blood transfusion times,blood transfusion volume and mechanical ventilation time between mild BPD group and moderate/severe BPD group( P < 0. 05). Conclusion: 1. The incidence rate of BPD in premature infants with gestational age of less than 32 weeks and less than 1500 g was higher. Combined RDS and invasive ventilation more than 7 days were the risk factors of BPD.
Objective: To investigate the risk factors of bronchopulmonary dysplasia( BPD) in preterm infants. Methods: The clinical data of premature infants with gestational age < 37 weeks and stay longer than 28 days in Pediatrics Department were analyzed retrospectively. According to the continuous use of oxygen ≥28 days after birth as standard,the 164 infants were divided into mild BPD group,moderate and severe BPD group according to the grading standard as well as non-BPD group. Incidence rate of premature infants BPD were analyzed from gestational age and body mass; comparing general information,perinatal period data and treatment data of premature infants from BPD group and non-BPD groups,as well as the three BPD groups; significant indexes were to be analyzed by multifactors Logistic regression analysis to detect risk factors of BPD incidence. Results: Premature infants with gestational age less than 32 weeks accounted for 85. 18% out of 54 diagnosed cases,and body mass less than 1500 g infants accounted for 666. 67%. The gestational age and body mass of BPD group infants were lower than non-BPD group; tube baby,5 min Apgar score < 8,RDS proportion,pulmonary infection,pulmonary hemorrhage,PS utilizing,NIPPV,IPPV premature infants proportion and blood transfusion volume were all higher than non-BPD group,differences were statistical significant( P < 0. 05). Logistic regression analysis showed that combined RDS and IPPV≥ 7 days were independent risk factors of BPD; There were significant differences in the history of premature rupture of membranes,septicemia,blood transfusion times,blood transfusion volume and mechanical ventilation time between mild BPD group and moderate/severe BPD group( P < 0. 05). Conclusion: 1. The incidence rate of BPD in premature infants with gestational age of less than 32 weeks and less than 1500 g was higher. Combined RDS and invasive ventilation more than 7 days were the risk factors of BPD.
引文
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[4]尹燕丹,祁媛媛,洪达,等.早产儿支气管肺发育不良危险因素级2岁时随访结局[J].中国循证儿科杂志,2016,11(2):113-117.
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[7]李雪华,沈月华,周静.支气管肺发育不良早产儿44例临床分析[J].中国新生儿科杂志,2015,30(6):433-437.
[8]王叶萍,戴玉璇,高原,等.小胎龄极低出生体重儿支气管肺发育不良的高危因素分析[J].浙江医学教育,2016,31(1):44-46.
[9] AUTEN R L,EKEKEZIE II. Blocking leukocyte influxand function to prevent chronic lungdisease ofprematurity[J]. Pediatr Pulmonol,2003,35:335-341.
[10]STENMARK K R,ABMAN S H. Lung vascular develop-ment:implications for the pathogenesis of bronchopulmo-nary dysplasia[J]. Annu Rev Physiol,2005,67:623-661.
[11]陈锦金.早产儿机械通气治疗后支气管肺发育不良的危险因素探讨[J].中国现代药物应用,2015,9(17):65-66.
[12]张琼,吴运芹,高喜容,等.影响超低和极低出生体重儿支气管肺发育不良严重程度的危险因素分析[J].中国新生儿科杂志,2016,31(6):401-404.
[13]ZHANG H,FANG J,SU H,et al. Risk factors for bron-chopulmonary dysplasia in neonates born at≤1 500 g(1999-2009)[J]. Pediatr Int,2011,3(6):915-920.
[2] THOMAS W,SPEER C P. Nonventilatory strategies forprevention and treatment of bronchopulmonary dysplasia--what is the evidence[J]. Neonatology,2008,94(3):150-159.
[3]武慧,韩彤妍,王新利,等.超低/极低出生体重儿支气管肺发育不良的危险因素[J].中国围产医学杂志,2016,19(10):761-765.
[4]尹燕丹,祁媛媛,洪达,等.早产儿支气管肺发育不良危险因素级2岁时随访结局[J].中国循证儿科杂志,2016,11(2):113-117.
[5]NORTHWAY W H,ROSAN R C,PORTER D Y. Pul-monary disease following respirator therapy of hyalinemembrane disease[J]. N Engl J Med,1967,(16):276-280.
[6]张媛柯,肖群文,李琪,等.早产儿支气管肺发育不良发生率及临床危险因素分析[J].中国新生儿科杂志,2016,31(3):198-200.
[7]李雪华,沈月华,周静.支气管肺发育不良早产儿44例临床分析[J].中国新生儿科杂志,2015,30(6):433-437.
[8]王叶萍,戴玉璇,高原,等.小胎龄极低出生体重儿支气管肺发育不良的高危因素分析[J].浙江医学教育,2016,31(1):44-46.
[9] AUTEN R L,EKEKEZIE II. Blocking leukocyte influxand function to prevent chronic lungdisease ofprematurity[J]. Pediatr Pulmonol,2003,35:335-341.
[10]STENMARK K R,ABMAN S H. Lung vascular develop-ment:implications for the pathogenesis of bronchopulmo-nary dysplasia[J]. Annu Rev Physiol,2005,67:623-661.
[11]陈锦金.早产儿机械通气治疗后支气管肺发育不良的危险因素探讨[J].中国现代药物应用,2015,9(17):65-66.
[12]张琼,吴运芹,高喜容,等.影响超低和极低出生体重儿支气管肺发育不良严重程度的危险因素分析[J].中国新生儿科杂志,2016,31(6):401-404.
[13]ZHANG H,FANG J,SU H,et al. Risk factors for bron-chopulmonary dysplasia in neonates born at≤1 500 g(1999-2009)[J]. Pediatr Int,2011,3(6):915-920.