摘要
目的回顾性分析支气管肺发育不良(BPD)伴肺动脉高压(PH)的临床特点及转归,并分析其高危因素。方法采用回顾性病例对照研究,纳入南方医科大学附属深圳妇幼保健院新生儿重症监护病房2016年1月至2018年12月收治的所有338例BPD患儿的临床资料。根据是否伴发PH分为BPD无PH组和BPD伴PH组,采用χ2检验、非参数检验分析两组的临床特点及转归;构建二分类Logistic回归模型分析BPD伴PH的危险因素。结果338例BPD患儿中无PH组314例(92.9%)、伴PH组24例(7.1%);出生胎龄为(27.1±1.8)周,其中男206例、女132例。BPD伴PH组患儿出生胎龄和体重均低于无PH组[(26.4±2.1)比(27.2±1.7)周、(798±255)比(1003±240)g,t=2.201、4.030,P=0.028、<0.01],住院期间有创机械通气时间、无创辅助通气时间均高于无PH组[14.3(2.1,43.7)比0.5(0,4.7)d,30.0(22.5,64.2)比15.0(7.0,26.0)d,Z=-4.838、-4.553,P均<0.01];BPD伴PH组母亲妊娠期高血压、小于胎龄(SGA)、晚发型败血症、呼吸机相关性肺炎、有血流动力学影响的动脉导管未闭(hsPDA)、需手术结扎的PDA、重度BPD、严重宫外生长发育迟缓(EUGR)发生率均高于无PH组[20.8%(5/24)比6.4%(20/314)、33.3%(8/24)比7.6%(24/314)、54.2%(13/24)比7.3%(23/314)、25.0%(6/24)比6.1%(19/314)、75.0%(18/24)比39.2%(123/314)、45.8%(11/24)比1.9%(6/314)、66.7%(16/24)比7.3%(23/314),75.0%(18/24)比45.5%(143/314),P均<0.05]。多因素Logistic回归分析结果显示母亲妊娠期高血压(OR=12.950,95%CI:1.740~96.385),重度BPD(OR=10.160,95%CI:2.725~37.884),SGA(OR=4.992,95%CI:1.432~16.920),需要手术结扎的PDA(OR=19.802,95%CI:3.297~118.921),严重EUGR(OR=20.316,95%CI:2.221~185.853)是BPD伴PH发生的独立危险因素。24例PH患儿中轻度7例、中度8例均存活,重度9例中4例死亡,存活PH患儿中最晚校正年龄1岁2月龄脱离吸氧。结论PH是BPD的严重并发症,伴随着高病死率,建议具有高危因素的BPD患儿应定期筛查心脏超声,出院后定期随访。
Objective To analyze clinical features,prognosis and risk factors of bronchopulmonary dysplasia(BPD)associated pulmonary hypertension(PH).Methods Clinical data of 338 infants with BPD were collected from the neonatal intensive care unit(NICU)in Shenzhen Maternity and Child Healthcare Hospital,Southern Medical University between January 2016 and December 2018.These infants were divided into PH group and non-PH group.The clinical features and prognosis were compared between these two groups by Chi-square test or nonparametric test.Risk factors for BPD-PH were analyzed with binary logistic regression model.Results Among the 338 BPD infants,314 had no PH(92.9%)and 24 had PH(7.1%),with an average gestational age of(27.1±1.8)weeks,and 206 were males and 132 females.PH infants had younger gestational age(26.4±2.1)vs.(27.2±1.7)weeks,t=2.201,P=0.028)and lower birth weight(798±255)vs.(1003±240)g,t=4.030,P<0.01),compared to non-PH infants.Besides,duration of mechanical ventilation and non-invasive positive pressure ventilation were higher in PH group than that in non-PH group(14.3(2.1,43.7)vs.0.5(0,4.7)d,Z=-4.553,P<0.01;30.0(22.5,64.2)vs.15.0(7.0,26.0)d,Z=-4.838,P<0.01).The proportions of maternal hypertension,small for gestational age(SGA),late onset sepsis,ventilator associated pneumonia,hemodynamically significant patent ductus arteriosus(hsPDA),patent ductus arteriosus(PDA)requiring ligation,severe BPD and severe extrauterine growth retardation(EUGR)were higher in PH group than those in non-PH group((20.8%(5/24)vs.6.4%(20/314),33.3%(8/24)vs.7.6%(24/314),54.2%(13/24)vs.7.3%(23/314),25.0%(6/24)vs.6.1%(19/314),75.0%(18/24)vs.39.2%(123/314),45.8%(11/24)vs.1.9%(6/314),66.7%(16/24)vs.7.3%(23/314),75.0%(18/24)vs.45.5%(143/314),all P<0.05).Multivariate logistic regression analysis showed that maternal hypertension(OR=12.950,95%CI:1.740-96.385),severe bronchopulmonary dysplasia(OR=10.160,95%CI:2.725-37.884),SGA(OR=4.992,95%CI:1.432-16.920),PDA requiring ligation(OR=19.802,95%CI:3.297-118.921),severe EUGR(OR=20.316,95%CI:2.2
作者
陈春
黄鹏
林冰纯
陈雪雨
赵捷
孙红岩
余彦亮
陈姗
邱晓媚
杨传忠
Chen Chun;Huang Peng;Lin Bingchun;Chen Xueyu;Zhao Jie;Sun Hongyan;Yu Yanliang;Chen Shan;Qiu Xiaomei;Yang Chuanzhong(Department of Neonatology,Shenzhen Maternity and Child Healthcare Hospital,Southern Medical University,Shenzhen 518000,China)
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2020年第9期747-752,共6页
Chinese Journal of Pediatrics
基金
深圳市"医疗卫生三名工程"项目(SZSM201612045)。
关键词
支气管肺发育不良
高血压
肺性
危险因素
早产
婴儿
极低出生体重
婴儿
超低出生体重
Bronchopulmonary dysplasia
Hypertension,pulmonary
Risk factors
Premature birth
Infant,very low birth weight
Infant,extremely low birth weight
