极低出生体重儿支气管肺发育不良影响因素分析  

Analysis of influencing factors of very low birth weight infants with bronchopulmonary dysplasia

作　　者：张林 杨晓燕[1] 石晶 

机构地区：[1]四川大学华西第二医院儿科,成都610041 [2]简阳市人民医院新生儿科,四川641400

出　　处：《中华妇幼临床医学杂志（电子版）》2017年第5期518-523,共6页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：国家临床重点专科建设项目(1311200003303);四川省卫生计生委科研课题(150107);四川省科技厅应用基础研究项目(2016JY0180)~~

摘　　要：目的探讨极低出生体重儿(VLBWI)发生支气管肺发育不良(BPD)的影响因素。方法选择2015年1月至12月,四川大学华西第二医院新生儿重症监护室收治的163例VLBWI为研究对象。按照出院诊断是否包括BPD,将其分为BPD组(n=57)及非BPD组(n=106)。回顾性分析VLBWI临床病例资料,统计学比较下面各项因素对于VLBWI发生BPD的影响。(1)2组VLBWI母亲产前一般临床资料,包括年龄、胎次、是否初产妇、是否多胎妊娠、是否按期规律进行产前检查、分娩时并发症发生情况、分娩方式等12项因素;(2)新生儿情况,包括胎龄,出生体重,性别,出生后1min及5min Apgar评分,出生后肺表面活性物质(PS)使用情况,机械通气使用率及时间,以及生后合并症发生情况等14项因素。根据临床经验及VLBWI发生BPD的单因素分析结果,对其中13项影响因素,进一步进行多因素非条件logistic回归分析,探讨VLBWI发生BPD的独立影响因素。结果 (1)单因素分析结果显示:BPD组VLBWI母亲妊娠期高血压或子痫前期,以及剖宫产比例,均较非BPD组低,而产前出血比例,则较非BPD组高,并且差异均有统计学意义(P<0.05);BPD组VLBWI胎龄较非BPD组小,出生体重较非BPD组轻;BPD组VLBWI出生后1 min及5 min Apgar评分≤7分所占比例、PS使用率、机械通气率及时间,以及新生儿呼吸窘迫综合征(NRDS)、动脉导管未闭(PDA)和脑室周-脑室内出血/脑室周围白质软化(PIVH/PVL)发生率,则均较非BPD组高或长,并且上述差异均有统计学意义(P<0.05)。(2)VLBWI发生BPD影响因素的多因素非条件logistic回归分析结果显示:胎龄<29.5周(OR=3.876,95%CI:1.260~11.924,P<0.05),出生体重<1 300g(OR=3.983,95%CI:1.165~13.621,P<0.05)是VLBWI发生BPD的独立危险因素;机械通气时间<7d(OR=0.146,95%CI:0.050~0.424,P<0.05)是VLBWI是否发生BPD的独立保护因素。结论避免早产及合理的机械通气策略,可能降低VLBWI的BPD发生率。Objective To explorer the influencing factors of very low birth weight infants（VLBWI）with bronchopulmonary dysplasia（BPD）.Methods A total of 163 VLBWI in neonatal intensive care unit of West China Second University Hospital,Sichuan University,from January to December 2015,were chosen as study subjects.They were divided into BPD group（n=57）and non BPD group（n=106）according to discharged diagnosis.Clinical data were analyzed retrospectively,and following factors were compared statistically to explore the influences on BPD in VLBWI.（1） A total of 12 items of maternal prenatal conditions between 2 groups,including age,parity,primiparity,multifetation,regular prenatal examination,complications at delivery,delivery mode,etc..（2） A total of 14 items of neonatal conditions,including gestational age,birth weight,gender,1min and 5min Apgar scores,postnatal usage of pulmonary surfactant（PS）,usage rate and duration of mechanical ventilation and postnatal complications.etc..Based on the results of existing studies,clinical experience and results of univariate analysis,multivariate unconditional logistic regression analysis was performed about the 13 factors with significant differences,in order to discuss independent impact factors about BPD in VLBWI.Results（1）Results of univariate analysis showed that：the ratio of hypertension or preeclampsia during pregnancy and caesarean section of maternal in BPD group were lower than those of non BPD group,but the ratio of antepartum hemorrhage was higher than that of non BPD group,and the differences were statistically significant（P〈0.05）.Gestational age and birth weight of VLBWI in BPD group were younger or lighter than those of non BPD group.Ratio of Apgar score≤7 scores of 1min and 5min after birth,usage rate of PS,usage rate and duration of mechanical ventilation,incidence rates of neonatal respiratory distress syndrome（NRDS）, patent ductus arteriosus（PDA） and periventricular-intraventricular hemorrhage/periventricular leukomalacia�

关 键 词：支气管肺发育不良 危险因素 婴儿 极低出生体重 

分 类 号：R722.6[医药卫生—儿科]