极低出生体重儿输血治疗及危险因素分析  

Risk factors affecting treatment status of blood transfusion in very low birth weight infants

作　　者：李丽霞[1] 蒋叶均[1] 李海静[1] 李娅凤[1] 

机构地区：[1]浙江省绍兴市妇幼保健院新生儿监护中心,312000

出　　处：《中国新生儿科杂志》2015年第1期39-42,共4页Chinese Journal of Neonatology

摘　　要：目的分析本院极低出生体重儿的输血状况及危险因素。方法回顾性分析本院2011—2013年收治的胎龄<37周、出生体重<1500 g、住院时间≥7天的早产儿资料,按是否输血分为输血组及未输血组,记录并比较两组早产儿的一般情况、合并症、输血组早产儿输血前临床症状、输血前血红蛋白值(Hb)和红细胞压积(Hct)以及输血时间等,Logistic回归分析极低出生体重儿输血的相关因素。结果研究纳入的142例极低出生体重儿中需输悬浮红细胞51例,占35.9%,68例次;贫血症状主要有需氧疗、经皮氧饱和度不稳定、心率快、需机械通气、体重不增等。输血组出生体重、胎龄低于未输血组,出生窒息、出生需气管插管、CPAP支持、呼吸窘迫综合征(RDS)、肺炎、支气管肺发育不良发生率高于未输血组,住院天数长于未输血组,差异有统计学意义(P<0.05);两组败血症和坏死性小肠结肠炎发生率差异无统计学意义(P>0.05)。Logistic回归分析显示,胎龄(OR=0.400)和体重(OR=0.994)是极低出生体重儿输血的保护性因素,肺炎(OR=3.620)和RDS(OR=3.863)是极低出生体重儿输血的独立危险因素(P均<0.05)。结论极低出生体重儿出生胎龄小、体重低、患RDS或肺炎时输血风险明显增加,对于贫血伴有临床缺氧症状的极低出生体重儿应输血治疗。Objective To study the treatment status of blood transfusion and its associated risk factors in very low birth weight （VLBW） infants born at the ShaoXing Maternal and Child Health Center.Methods One hundred and forty-two preterm neonates born between 2011-2013 with birth weight ＜ 1500 g and hospital stay duration ≥1 week were recruited for this study.Infants were divided into two groups according to whether they had or had not received blood transfusions.General health condition during admission,medical complications,hematocrit （Hct） and hemoglobin （Hb） levels,as well as timing of transfusion were compared.Logistic Regression Analysis was then conducted to find out risk factors of blood transfusions.Results Among the 132 VLBW infants,51 （35.9％） received total of 68 pRBC transfusions.Major anemia symptoms in premature infants include Oxygen supplementation,SPO2 instability,tachycardia,need for mechanical ventilation and poor weight gain.Comparing to the infants in the non-transfusion group,infants who received transfusion had significantly lower birth weight and gestational age,significantly higher incidence of asphyxia,need for intubation and continuous positive airway pressure （CPAP）.They also experienced a higher occurrence of neonatal respiratory distress syndrome （RDS）,pneumonia,bronchopulmonary dysplasia （BPD）,and prolonged hospital stay （P ＜ 0.05）.Occurrence of neonatal sepsis and necrotizing enterocolitis were similar between the two groups （P ＞ 0.05）.Further logistic regression analysis revealed that gestational age,birth weight,complications of RDS and pneumonia were main risk factors for premature VLBW babies receiving blood transfusion （P ＜ 0.05）.Conclusions Lower gestation,lower birth weight,RDS and pneumonia are associated with increased risk of blood transfusion in VLBW infants.Blood transfusion should be considered in anemic infants with hypoxia symptoms.

关 键 词：婴儿 极低出生体重 贫血 输血 危险因素 

分 类 号：R722.6[医药卫生—儿科]