摘要
目的以体重变化为观察点,探讨超早产儿住院期间不良结局与生后早期液体管理间的相关性。方法选择2019年1月至2023年3月成都市妇女儿童中心医院新生儿重症监护室收治的超早产儿进行回顾性分析,根据生后前3 d体重下降情况分为未降组、下降<6%组、下降6%~10%组、下降>10%组,比较4组患儿生后前7 d液体摄入量、住院期间有血流动力学意义的动脉导管未闭(hemodynamically significant patent ductus arteriosus,hsPDA)、需要手术结扎的PDA、有创机械通气时间、≥Ⅱ期的坏死性小肠结肠炎(necrotizing enterocolitis,NEC)、3~4级脑室内出血(intraventricular hemorrhage,IVH)、中度支气管肺发育不良(bronchopulmonary dysplasia,BPD)、重度BPD、死亡率及总住院时间情况。结果共纳入119例超早产儿,体重未降组41例,下降<6%组22例,下降6%~10%组31例,下降>10%组25例。4组患儿生后第1、5~7天摄入液量比较差异无统计学意义(P>0.05);下降6%~10%组、下降>10%组患儿生后第2~4天液体摄入量低于未降组,生后第4天液体摄入量低于下降<6%组及未降组,差异均有统计学意义(P<0.05)。下降6%~10%组、下降>10%组患儿hsPDA发生率低于未降组(P<0.05);下降>10%组患儿≥Ⅱ期NEC、中度BPD发生率低于未降组,有创机械通气时间及总住院时间短于未降组,差异均有统计学意义(P<0.05)。在需要手术结扎的PDA、3~4级IVH、重度BPD发生率、死亡率方面,4组间比较差异无统计学意义(P>0.05)。结论超早产儿生后早期(前3 d)一定程度体重下降,有利于降低hsPDA、NEC、中度BPD发生率,缩短有创机械通气时间及总住院时间。以体重管理为切入点辅助液体管理,可能有助于超早产儿在生后早期获得更加优化的液体管理方案。
Objective To study the correlation between adverse clinical outcomes and early postnatal weight loss(representing the results of fluid management)during hospitalization in extremely premature infants(EPIs).Methods From January 2019 to March 2023,EPIs(gestational age(GA)<28 weeks)admitted to neonatal intensive care unit(NICU)of our hospital were retrospectively analyzed.According to weight loss(WL)within the first 3 d after birth,the infants were assigned into no-WL group,WL<6%group,WL 6%-10%group and WL>10%group.The following items were compared among the four groups:fluid intake within the first 7 d after birth,the incidences of hemodynamically significant patent ductus arteriosus(hsPDA),PDA requiring surgical ligation,duration of invasive mechanical ventilation,≥stage II necrotizing enterocolitis(NEC),grade 3-4 intraventricular hemorrhage(IVH),moderate bronchopulmonary dysplasia(BPD),severe BPD,mortality rates and total length of hospital stay.Results A total of 119 EPIs were enrolled,including 41 in no-WL group,22 in WL<6%group,31 in WL 6%-10%group and 25 in WL>10%group.Among the four groups,no significant differences existed in fluid intake on d1 and d5-d7 after birth(P>0.05).WL 6%-10%and>10%groups had significantly lower fluid intake during d2-d4 than no-WL group(P<0.05).On d4,WL 6%-10%and>10%groups had lower fluid intake than WL<6%and no-WL groups(P<0.05).WL 6%-10%and>10%groups showed lower incidences of hsPDA than no-WL group(P<0.05).WL>10%group had lower incidences of≥stage II NEC,moderate BPD,shorter duration of invasive mechanical ventilation and total hospital stay than no-WL group(P<0.05).No significant differences existed in the incidences of PDA requiring surgical ligation,grade 3-4 IVH,severe BPD and mortality rates among the four groups(P>0.05).Conclusions For EPIs,a certain degree of WL within the first 3 d after birth is beneficial to reduce the incidences of hsPDA,NEC,moderate BPD,duration of invasive mechanical ventilation and total hospital stay.Focusing on body weight is helpful for a mo
作者
李华英
钟林平
秦膏阳
魏国清
巨容
Li Huaying;Zhong Linping;Qin Gaoyang;Wei Guoqing;Ju Rong(Department of Neonatology,Chengdu Women's and Children's Central Hospital,School of Medicine,University of Electronic Science and Technology of China,Chengdu 611731,China)
出处
《中华新生儿科杂志（中英文）》
CAS
CSCD
2024年第2期95-99,共5页
Chinese Journal of Neonatology
基金
国家自然科学基金面上项目(82171697,82101805)
四川省科技厅面上项目(2021YJ0190)
四川省卫生健康委医学科技项目(21PJ129)。
关键词
超早产儿
液体管理
体重
动脉导管
支气管肺发育不良
Extremely premature infant
Fluid management
Weight
Ductus arteriosus
Bronchopulmonary dysplasia
