行机械通气治疗的早产儿发生支气管肺发育不良的危险因素
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摘要
目的探讨新生儿重症监护病房(NICU)行机械通气治疗的早产儿发生支气管肺发育不良(BPD)的危险因素。方法选取98例接受机械通气治疗的早产儿为研究对象,根据其是否发生BPD将其分为BPD组(23例)和非BPD组(75例)。对BPD发生的危险因素进行单因素和多因素回归分析。结果早产儿支气管肺发育不良的发病率为23.47%;两组早产儿的胎龄、出生体质量、胎膜早破史、合并呼吸窘迫综合征、合并感染、合并动脉导管未闭、总吸氧时间、应用静脉营养时间、吸气峰压、呼气末正压、平均气道压力、机械通气时间以及最高氧浓度比较,差异有统计学意义(P<0.05);出生体质量、合并呼吸窘迫综合征、应用静脉营养时间、机械通气时间以及机械通气最高氧浓度是机械通气早产儿发生支气管肺发育不良的独立危险因素。结论降低机械通气时间、机械通气最高氧浓度,及控制呼吸窘迫综合征的发病率能有效预防NICU机械通气早产儿支气管肺发育不良的发生。
Objective To investigate the risk factors of bronchopulmonary dysplasia( BPD) in premature infants with mechanical ventilation treatment in neonatal intensive care unit( NICU).Methods A total of 98 premature infants who received mechanical ventilation treatment were selected and divided into BPD group( 23 cases) and non BPD group( 75 cases) according to whether BPD occurred. The risk factors of BPD were analyzed by univariate and multivariate regression analysis.Results The incidence of BPD was 23. 47 %; there were significant differences in gestational age,birth weight,history of premature rupture of membranes( PROM),complicated neonatal respiratory distress syndrome( NRDS),concurrent infection,concurrent patent ductus arteriosus,oxygen time,intravenous nutrition time,peak inspiratory,positive end-expiratory pressure,mean airway pressure,mechanical ventilation time and oxygen administration between the two groups( P < 0. 05). Birth weight,combined respiratory distress syndrome,intravenous nutrition time,mechanical ventilation time,and maximum oxygen concentration of mechanical ventilation were the independent risk factors of bronchopulmonary dysplasia in premature infants with mechanical ventilation. Conclusions Reducing the time of mechanical ventilation and the maximum oxygen concentration of mechanical ventilation and controlling the incidence of respiratory distress syndrome can effectively prevent the occurrence of bronchopulmonary dysplasia in NICU mechanical ventilation preterm infants.
Objective To investigate the risk factors of bronchopulmonary dysplasia( BPD) in premature infants with mechanical ventilation treatment in neonatal intensive care unit( NICU).Methods A total of 98 premature infants who received mechanical ventilation treatment were selected and divided into BPD group( 23 cases) and non BPD group( 75 cases) according to whether BPD occurred. The risk factors of BPD were analyzed by univariate and multivariate regression analysis.Results The incidence of BPD was 23. 47 %; there were significant differences in gestational age,birth weight,history of premature rupture of membranes( PROM),complicated neonatal respiratory distress syndrome( NRDS),concurrent infection,concurrent patent ductus arteriosus,oxygen time,intravenous nutrition time,peak inspiratory,positive end-expiratory pressure,mean airway pressure,mechanical ventilation time and oxygen administration between the two groups( P < 0. 05). Birth weight,combined respiratory distress syndrome,intravenous nutrition time,mechanical ventilation time,and maximum oxygen concentration of mechanical ventilation were the independent risk factors of bronchopulmonary dysplasia in premature infants with mechanical ventilation. Conclusions Reducing the time of mechanical ventilation and the maximum oxygen concentration of mechanical ventilation and controlling the incidence of respiratory distress syndrome can effectively prevent the occurrence of bronchopulmonary dysplasia in NICU mechanical ventilation preterm infants.
引文
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[2]吴晨,邓春.新生儿呼吸窘迫征并发支气管肺发育不良的高危因素[J].重庆医科大学学报,2017,42(8):1016-1022.DOI:10.13406/j.cnki.cyxb.001340.
[3]陈超,袁琳.早产儿支气管肺发育不良的病因及危险因素[J].中国实用儿科杂志,2014,29(1):5-7.
[4]Gudmundsdottir A,Johansson S,Hakansson S,et al.Timing of pharmaeologieal treatment for patent ductus arteriesus and risk of secondary su Fgery,death or bmnehopulmonary dysplasia:a population based cohort study of extremely preterm infants[J].Neonatology,2015,107(2):87-92.DOI:10.1159/000371789.
[5]黄静兰,王华,唐军,等.不同胎龄早产儿支气管肺发育不良的影响因素[J].中华实用儿科临床杂志,2017,32(14):1073-1075.
[6]齐利峰,麦玉真,姚芳.支气管肺发育不良合并肺动脉高压危险因素的Logistic回归分析[J].南京医科大学学报(自然科学版),2015,35(7):1022-1025.
[7]Duan J,Kong X,Li Q,et al.Association between anemia and bronehopulmonary dysplasia in preterm infants[J].Sci Rep,2016,3(6):22717.DOI:10.1038/srep22717.
[8]尹燕丹,祁媛媛,洪达.早产儿支气管肺发育不良危险因素及2岁时随访结局[J].中国循证儿科杂志,2016,11(2):113-117.
[9]任艳丽,孔祥永,杜志方.早产儿支气管肺发育不良危险因素前瞻性研究[J].中华实用儿科临床杂志,2015,30(10),757-760.
[10]Gibson AM,Reddington C,Mc Bride L,et al.Lung function in adult survivors of very low birth weight with and without bmnehopuimonary dysplasia[J].Pediatr Pulmonol,2015,50(10):987-994.DOI:10.1002/ppul.23093.
[11]叶鸿瑁,邵肖梅.实用新生儿学[M].4版.北京:人民卫生出版社,2011.
[12]陈尚勤,张维溪,张海邻,等.支气管肺发育不良8例患儿6年临床随访[J].中国循证儿科杂志,2012,7(1):55-58.
[13]Fratto VM,Ananth CV,Gyamll Bannennan C.Late preterm neonatal morbidity in hypertensive vemus normotcnsive women[J].Hypertens Pregnancy,2016,35(2):242-249.DOI:10.3109/10641955.2016.1139720.
[14]Vom Hove M,Prenzel F,Uhlig H,et al.Pulmonary outcome in former preterm,ery low birth weight children with bronchopulmonary dysplasia:a case-control follow-up at school age[J].J Pediatr,2014,164(1):40-45.DOI:10.1016/j.jpeds.24055328.
[15]Reseh B,Gutmann C,Reiterer F,et al.Neonatal ureaplasnm urealytleum colonization increases pulmonary and cerebral morbidity despite treatment maerolide antibiotics[J].Infection,2016,44(3):323-327.DOI:10.1007/s15010-015-0858-7.