摘要
目的探讨超低出生体重儿支气管肺发育不良(bronchopulmonarydysplasia,BPD)的发生情况及重度BPD的危险因素。方法选择2007年1月至2017年1月本院新生儿重症监护病房收治的超低出生体重儿临床资料进行回顾性研究,分析BPD发生情况,并将BPD患儿分为重度BPD组和轻中度BPD组,对两组患儿一般情况、孕母情况、产前和产房处理、转运情况、治疗情况、住院期间疾病发生情况及临床转归情况进行比较,分析重度BPD的危险因素。结果研究期间共收治超低出生体重儿367例,其中存活日龄≥28d且资料完整281例,诊断BPD233例。重度BPD组116例,死亡47例(40.5%);轻中度BPD组117例,死亡1例(0.9%),两组病死率差异有统计学意义(P<0.05)。多因素Logistic回归分析显示机械通气≥7d(OR=7.518,95%CI3.197~17.676)、呼吸机相关性肺炎(OR=3.047,95%CI1.436~6.464)、1minApgar评分≤7分(OR=2.341,95%CI1.142~4.796)、动脉导管未闭(OR=2.223,95%CI1.079~4.582)是发生重度BPD的危险因素。结论超低出生体重儿BPD发生率尤其是重度BPD比例高、病死率高,减少窒息、缩短机械通气时间、积极预防感染、关闭动脉导管是降低BPD严重程度的重要措施。
Objective To study the occurrence of bronchopulmonary dysplasia (BPD) in extremely low birth weight (ELBW) infants and to determine the risk factors of severe BPD. Method From January 2007 to January 2017, ELBW infants admitted to neonatal intensive care unit (NICU) in Hunan Children′s Hospital were retrospectively analyzed. They were assigned into severe and mild/moderate groups based on the severity of BPD. The general condition, maternal status, prenatal and delivery room treatment, transportation, clinical courses, therapy and outcome in NICU of the two groups were compared, and the risk factors of severe BPD were analyzed. Result A total of 367 cases were hospitalized during the 10 years. 281 ELBW infants with complete medical records survived longer than 28 days were enrolled in this study. Among them, 233 had BPD. Among BPD infants, 116 cases were in the severe BPD group, 47 cases (40.5%) died. 117 cases were in the mild/moderate BPD group and 1 case (0.9%) died. The difference between the two groups was statistically significant (P<0.05). Multivariate Logistic regression analysis showed that the risk factors of severe BPD were duration of mechanical ventilation≥7 days (OR=7.518, 95%CI 3.197~17.676), ventilator-associated pneumonia (OR=3.047, 95%CI 1.436~6.464), 1 min Apgar score≤7 (OR=2.341, 95%CI 1.142~4.796) and patent ductus arteriosus (OR=2.223, 95%CI 1.079~4.582). Conclusion The incidence and mortality of BPD, especially severe BPD, are high in ELBW infants. Avoiding asphyxia, shortening the time of mechanical ventilation, preventing infection and closing ductus arteriosus are important measures to reduce the severity of BPD.
作者
吴运芹
谢晶晶
高喜容
李强
刘新晖
庄严
马金霞
常淑婷
Wu Yunqin;Xie Jingjing;Gao Xirong;Li Qiang;Liu Xinhui;Zhuang Yan;Ma Jinxia;Chang Shuting(Neonatal Department, Hunan Children′s Hospital, Changsha 410007, China)
基金
湖南省卫生计生委科研计划课题 (B2014-126).
关键词
婴儿
超低出生体重
支气管肺发育不良
危险因素
Infant, extremely low birth weight
Bronchopulmonary dysplasia
Risk factors
