极低出生体重儿支气管肺发育不良42例临床分析
摘要
[目的]了解及探讨极低出生体重儿(very low birth weight infant, VLBWI)支气管肺发育不良(bronchopulmonary dysplasia, BPD)的发生情况、病因、临床特点、诊断、病情分度、治疗和转归,以及各因素与其病情分度之间的关系,为BPD的疾病预防、早期诊断、合理治疗提供临床依据。
[方法]回顾性分析42例BPD病例的病历资料,对其胎龄、出生体重、原发疾病、实验室检查、影像学表现、诊疗经过及转归等临床资料进行分析。
[结果]2005年10月至2010年3月在本院分娩VLBWI共986例,42例符合BPD的诊断,BPD发生率为4.26%。其中轻中度BPD19例(45.2%),中度BPD18例(42.9%),重度BPD5例(11.9%)。42例患儿平均胎龄28.0±1.7周；平均出生体重1050±189.0g；平均需氧时间66.5±27.9天。经典型BPD21例,新型BPD21例。平均住院天数81.8±23.9天；平均出院体重2934.75±729.36g；平均出院胎龄39.4±3.3周。所有患儿出生后2-3周胸片出现早期BPD影像学变化。32例完全脱氧出院；7例出院时需鼻导管间歇给氧(0.02-0.05L／min)；2例因病情反复,无法脱离机械通气,家属放弃治疗后死亡：1例因病情反复,家属要求转院。中重度患儿和轻度患儿比较,输血量更多(P<0.05),而其出生时体重胎龄、机械通气运用时间、生后激素的使用以及利尿剂、支气管扩张剂等药物应用与病情分度均无明显关联。
[结论]VLBWI肺发育不成熟、长时间吸氧及机械通气、肺部感染是BPD发生的主要因素,应加强对BPD的早期诊断及合理的综合治疗措施。同时注意早产儿的合理输血。
Objective:Understand and explore the incidence, etiology, clinical features, diagnosis, disease indexing, treatment and outcome of bronchopulmonary dysplasia in the very low birth weight infant (VLBWI), and the relationship between all factors and the severity of BPD, provide the clinical basis to intervention in risk factors, early diagnosis, treatment, and reduction of moderate, severe BPD.
Methods:42 cases of VLBWI with bronchopulrnonary dysplasia were analyzed retrospectively. Characteristics of gestation age, birth weight, primary disease, lung imaging, treatment process and prognosis were summarize and analyzed.
Results:A total of 983 VLBWI were born in the Women's Hospital during Oct 2005 and Mar 2010. The prevalence of BPD was 4.26%(42/983). The average gestational age of 42 cases is 28.0±1.7 weeks; average birth weight is 1050±189.0g; 19 mild BPD cases (45.2%),18 moderate cases (42.9%),5 severe cases (11.9%); 21 classic BPD cases,21 new BPD cases. All cases had early chest X-ray changes in 2-3 weeks.The average time for oxygen supplementation is 66.5±27.9 days; average time of hospital stay 81.8±23.9d; average weight at discharge 2934.75±729.36g; average gestational age at discharge 39.4±3.3 weeks.32 cases were clinically cured,7 cases required intermittent oxygen (0.02-0.05L/min); 2 cases dead; 1 case transfered. The infants with moderate to severe degree BPD need more blood transfusions(P<0.05) than the mild. Birth weight, gestational age, duration of mechanical ventilation, use of postnatal corticosteroids, bronchodilators, diuretics were not significantly associated with the severity of BPD.
Conclusion:Premature lung development, long time oxygen dependency and mechanical ventilation, pulmonary infection are the common causes of BPD. We should strengthen the early diagnosis of BPD and reasonable comprehensive treatments. And maybe we can adopt the more reasonable blood transfusion trigger in the VLBWI.
[方法]回顾性分析42例BPD病例的病历资料,对其胎龄、出生体重、原发疾病、实验室检查、影像学表现、诊疗经过及转归等临床资料进行分析。
[结果]2005年10月至2010年3月在本院分娩VLBWI共986例,42例符合BPD的诊断,BPD发生率为4.26%。其中轻中度BPD19例(45.2%),中度BPD18例(42.9%),重度BPD5例(11.9%)。42例患儿平均胎龄28.0±1.7周；平均出生体重1050±189.0g；平均需氧时间66.5±27.9天。经典型BPD21例,新型BPD21例。平均住院天数81.8±23.9天；平均出院体重2934.75±729.36g；平均出院胎龄39.4±3.3周。所有患儿出生后2-3周胸片出现早期BPD影像学变化。32例完全脱氧出院；7例出院时需鼻导管间歇给氧(0.02-0.05L／min)；2例因病情反复,无法脱离机械通气,家属放弃治疗后死亡：1例因病情反复,家属要求转院。中重度患儿和轻度患儿比较,输血量更多(P<0.05),而其出生时体重胎龄、机械通气运用时间、生后激素的使用以及利尿剂、支气管扩张剂等药物应用与病情分度均无明显关联。
[结论]VLBWI肺发育不成熟、长时间吸氧及机械通气、肺部感染是BPD发生的主要因素,应加强对BPD的早期诊断及合理的综合治疗措施。同时注意早产儿的合理输血。
Objective:Understand and explore the incidence, etiology, clinical features, diagnosis, disease indexing, treatment and outcome of bronchopulmonary dysplasia in the very low birth weight infant (VLBWI), and the relationship between all factors and the severity of BPD, provide the clinical basis to intervention in risk factors, early diagnosis, treatment, and reduction of moderate, severe BPD.
Methods:42 cases of VLBWI with bronchopulrnonary dysplasia were analyzed retrospectively. Characteristics of gestation age, birth weight, primary disease, lung imaging, treatment process and prognosis were summarize and analyzed.
Results:A total of 983 VLBWI were born in the Women's Hospital during Oct 2005 and Mar 2010. The prevalence of BPD was 4.26%(42/983). The average gestational age of 42 cases is 28.0±1.7 weeks; average birth weight is 1050±189.0g; 19 mild BPD cases (45.2%),18 moderate cases (42.9%),5 severe cases (11.9%); 21 classic BPD cases,21 new BPD cases. All cases had early chest X-ray changes in 2-3 weeks.The average time for oxygen supplementation is 66.5±27.9 days; average time of hospital stay 81.8±23.9d; average weight at discharge 2934.75±729.36g; average gestational age at discharge 39.4±3.3 weeks.32 cases were clinically cured,7 cases required intermittent oxygen (0.02-0.05L/min); 2 cases dead; 1 case transfered. The infants with moderate to severe degree BPD need more blood transfusions(P<0.05) than the mild. Birth weight, gestational age, duration of mechanical ventilation, use of postnatal corticosteroids, bronchodilators, diuretics were not significantly associated with the severity of BPD.
Conclusion:Premature lung development, long time oxygen dependency and mechanical ventilation, pulmonary infection are the common causes of BPD. We should strengthen the early diagnosis of BPD and reasonable comprehensive treatments. And maybe we can adopt the more reasonable blood transfusion trigger in the VLBWI.
引文
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