支气管肺发育不良的风险因素分析及生后第1年随访  

Risk Factors Analysis and a Follow-up of Preterm Infants with Bronchopulmonary Dysplasia in First Year of Life

作　　者：胡晓光[1] 张海邻[1] 张维溪[1] 郑仰明[1] 苏苗赏[1] 陈尚琴[2] 陈鲜威[2] 

机构地区：[1]温州医学院附属第二医院/育英儿童医院儿童呼吸科,325027 [2]温州医学院附属第二医院/育英儿童医院新生儿科,325027

出　　处：《医学研究杂志》2013年第6期148-153,共6页Journal of Medical Research

摘　　要：目的探讨支气管肺发育不良(BPD)的发生率及危险因素,评估生后1年内BPD患儿呼吸道疾病的患病率及再住院率,评估BPD患儿的肺功能。方法 2009年1月1日2009年12月31日出生并在笔者医院诊断为支气管肺发育不良(BPD)患儿的临床资料及母亲妊娠期间营养状况及相关环境因素;在患儿满1周岁后进行随访,调查1年内呼吸道感染次数、再入院次数、潮气肺功能及心脏B超。分别选取同性别年龄相当正常儿童作为对照组,对两组儿童的临床资料及随访资料进行对比分析。组间差异采用卡方检验、独立样本t检验或非参数检验;支气管肺发育不良的相关风险因素采用积差相关及Logistic逐步回归分析法。结果本研究共纳入BPD患儿24例,男性22例(91.7%),平均胎龄29.3±3.0周,平均出生体重1354.8±474.8g,活产新生儿BPD患病率为0.35%。24例中,12例为轻度BPD,中度7例,重度5例。生后第1年,BPD病死3例(13.3%),18例(87.5%)有下呼吸道感染病史及因此住院,对照组儿童住院率仅为14.3%。生后1年内,BPD组有18例(87.5%)患儿发生喘息37人次,对照组仅4人发生喘息,两组差异显著(χ2=20.47,P<0.001)。随访时BPD患儿的身高及体重均明显低于对照组儿童。心脏B超发现7例BPD患儿存在肺动脉高压,肺功能检查提示BPD患儿的达峰时间、达峰时间比、达峰容积及达峰容积比均明显低于对照组。经Logistic回归分析发现,母亲的妊娠年龄(P=0.004,OR=62.5)及母孕期体重增长量(P=0.04,OR=0.004)是PBD发生的独立风险因子;而机械通气时间(P=0.016)及母妊娠年龄(P=0.019)是BPD严重度的相关因素。结论 BPD在新生儿中的患病率为0.35%,在超低体重儿中患病率为15.5%。BPD患儿生后1年内下呼吸道感染率及再入院率明显高于正常儿童,小气道功能明显低于正常儿童。母亲高龄妊娠及母孕期体重增长过低可能亦是BPD的危险因素之一。Objective To investigate the incidence and risk factors of bronchopulmonary dysplasia （ BPD ） and follow - up the patients with BPD when they were 1 year old to determine the morbidity of respiratory tract infection, rehospitalization ratio and lung function. Methods Infants who were diagnosed as BPD in our hospital between January 1,2009 and December 31, 2009 were screened. Data including nutritional status and environmental factors of the mother during pregnancy, delivery history, were collected. We followed up the patients, and at 12 to 15 month＇s postmenstrual age, assessed echo cardiography, frequency of respiratory tract infection and re -hospitalization. We selected equal number of normal children with similar age and gender as control group and compared data including lung function between infants with and without BPD. Results This study finally enrolled 24 BPD cases, revealed a BPD prevalence of 0.35% in live birth newborns. The average birth weight of those BPD infant were 1354.8± 474.8 g, mean gestational age 29.3 ± 3.0 weeks. Out of those 24 cases, 22 were males （91.7%） , 12 were mild BPD, 7 moderate and 5 severe. There were 3 BPD infants died （13.3%） within the first year of life, 18 cases （87.5%） had history of lower respiratory tract infection and therefore hospitalized, that was only ld. 3% in control group. One year after birth, compared with that only 4 children had history of wheezing in control group, there were 18 children （87.5%） in BPD group who had 37 episodes of wheezing（χ2 = 20.47,P 〈 0. 001 ）. During the follow up, the height and weight of the BPD infants were significantly lower than those in control group. Echo cardiography showed 7 cases of BPD children with pulmonary hypertension, and pulmonary function test suggested that the peak time, peak time ratio, peak volume and peak volume ratio were significantly lower than those in control group. Logistic regression analysis found that the mother＇s gestational age （P = 0. 004,OR = 62.5） and the a- moun

关 键 词：支气管肺发育不全 肺功能 风险因素 随访 

分 类 号：R722.6[医药卫生—儿科]