支气管肺发育不良早产儿早期肺外合并症的临床分析  

Clinical analysis of the early extrapulmonary complications in preterm infants with bronchopulmonarydysplasia

作　　者：侯阿娜[1] 张妮[1] 富建华[1] 薛辛东[1] 

机构地区：[1]中国医科大学附属盛京医院新生儿科,沈阳110004

出　　处：《中国小儿急救医学》2017年第4期273-277,共5页Chinese Pediatric Emergency Medicine

基　　金：国家自然科学基金（81601331,81471489）

摘　　要：目的通过对支气管肺发育不良（bronchopulmonarydysplasia，BPD）早产儿生后早期脑室周围一脑室内出血（periventricularintraventricularhemorrhage，PVH-IVH）、脑白质损伤、胃肠外营养相关性胆汁淤积综合征（parenteralnutritionassociatedcholestasis，PNAC）及代谢性骨病发病情况的临床分析，以期对BPD患儿肺外并发症的预防和监测进行指导。方法回顾性分析2014年9月至2015年12月于中国医科大学附属盛京医院新生儿病房住院并明确诊断BPD的87例早产儿（BPD组），随机选择同期住院非BPD早产儿90例为对照组（非BPD组），分析两组PVH-1VH、脑白质损伤、PNAC及代谢性骨病等肺外并发症的发生率。结果BPD组早产儿PVH—IVH发病率[26．4％（23／87）]高于非BPD组[11．1％（10／90）]（P〈0．01），其中BPD组I-Ⅱ级PVH—IVH发病率也明显升高[24．1％（21／87）比11．1％（10／90）]（P〈0．05），而Ⅲ～Ⅳ级PVH—IVH发生率两组比较差异无统计学意义（P〉0．05）。BPD组早产儿脑白质损伤发生率[33．3％（29／87）]明显高于非BPD组[16．7％（15／90）]（P〈0．05），其中的严重类型脑室周围白质软化的发生率BPD组也明显增高[13．7％（12／87）比2．2％（2／90）]（P〈0．05）。此外，BPD组早产儿PNAC[22．9％（20／87）比5．5％（5／90）]、代谢性骨病[17．2％（15／87）比3．3％（3／90）]及代谢性骨病中有影像学改变[6．9％（6／87）比0]的发生率均高于非BPD组，差异均有统计学意义（P〈0．05）。结论BPD患儿较非BPD早产儿更易合并PVH—IVH、脑白质损伤、PNAC及代谢性骨病等早期肺外并发症，生后早期合理预防及定期监测肺外并发症的发生对提高BPD患儿生存质量至关重要。Objective To clinically analyze the incidence of early extrapulmonary complications in premature infants with bronchopulmonary dysplasia （BPD）, including periventricular intraventricular hemor- rhage （ PVH-IVH）, white matter injury （ WMI）, parenteral nutrition associated cholestasis （PNAC） and meta- bolic bone disease（MBD）,in order to direct the prevention and monitoring of these complications in BPD patients. Methods The clinical data of premature infants who were admitted to the neonatal depamnent between September 2014 and December 2015 was retrospectively analyzed. A total of 87 premature infants diagnosed with BPD were studied as BPD group, while other 90 premature infants without BPD who were hospitalized at the same time were randomly selected as non BPD group. The occurrence of several common extrapulmonary complications was compared between two groups, including PVH-IVH, WMI, PNAC and MBD. Results The incidence of PVH-IVH in BPD group increased compared with non BPD group E （26.4% （23/87） vs. 11.1% （ 10/90 ） ] （ P 〈 0. 01 ） , grade I - I/ PVH-IVH was more often seen in the BPD group too E 24. 1% （ 21/87 ） vs. 11.1% （ 10/90 ） ] （ P 〈 0. 05 ）, although the difference between two groups regarding the incidence of grade HI-IV PVH-IVH was not significant （ P 〉 0. 05 ）. The incidence of WMI in BPD group was much higher than that in non BPD group-33. 3% （29/87） vs. 16. 7% （15/90） ] （ P 〈 0. 05 ）, especially periventricular leukomalacia, the severe type of WMI, was more often found in BPD group than that in non BPD group- 13.7% （12/87） vs. 2. 2% （2/90） ] （P 〈0. 05）. The incidences of PNAC I22. 9% （20/87） vs. 5.5% （5/90） ] ,MBDE 17.2% （15/87） vs. 3.3% （3/90） ] and MBD with imaging changes - 6. 9% （6/87） vs. 0 ] were all higher in BPD group compared with non BPD group, with significant differences between the two groups （P 〈 0. 05）. Conclusion BPD patients are more likely to have earlyextrapulmonary compli

关 键 词：支气管肺发育不良 肺外并发症 脑室周围一脑室内出血 脑白质损伤 胃肠外营养相关 性胆汁淤积综合征 代谢性骨病 

分 类 号：R722.6[医药卫生—儿科]