胎龄<32周超低出生体质量儿支气管肺发育不良的危险因素分析及早期预测  

Risk factors and early prediction of bronchopulmonary dysplasia in extremely low birth weight infants with gestational age<32 weeks

作　　者：徐豆豆[1] 高慧 张晶玲 王杨[1] XU Doudou;GAO Hui;ZHANG Jingling;et al(Department of Pediatrics,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院儿科,合肥230022

出　　处：《安徽医学》2021年第7期713-717,共5页Anhui Medical Journal

基　　金：安徽省科技厅公益技术应用研究联动计划项目(项目编号:1704f0804018);安徽省卫生计生适宜技术推广项目(项目编号:2016-RK01)。

摘　　要：目的探讨胎龄<32周超低出生体质量儿支气管肺发育不良(BPD)的高危因素及新生儿急性生理学评分围产期补充Ⅱ(SNAPPE-Ⅱ)对BPD发生风险的预测价值。方法回顾性分析2015年1月至2020年10月安徽医科大学第一附属医院新生儿重症监护病房收治的106例胎龄<32周超低出生体质量儿的病历资料。依据是否发生BPD分为BPD组(75例)和非BPD组(31例),两组研究对象入院12 h内进行新生儿急性生理学评分围产期补充Ⅱ(SNAPPE-Ⅱ)评分。采用单因素分析与多因素logistic回归分析筛选发生BPD的危险因素,采用受试者工作特征(ROC)曲线分析SNAPPE-Ⅱ评分预测BPD发生的价值。结果BPD组胎龄小于非BPD组,产前使用糖皮质激素、胎膜早破≥18 h、合并新生儿肺炎的比例以及SNAPPE-Ⅱ评分均高于非BPD组,且机械通气时间和住院时间均长于非BPD组,差异均为统计学意义(P均<0.05)。多因素logistic回归分析显示,小胎龄、机械通气时间长及高SNAPPE-Ⅱ评分是胎龄<32周超低出生体质量儿发生BPD的危险因素(P均<0.05)。SNAPPE-Ⅱ评分预测胎龄<32周超低出生体质量儿BPD发生的ROC曲线下面积为0.778(95%CI:0.688~0.869,P<0.05),截断值为27.0分,敏感性和特异性分别为66.7%和77.4%。结论对于胎龄<32周超低出生体质量儿,胎龄越小、SNAPPE-Ⅱ评分越高、机械通气时间越长,发生BPD的风险越高。SNAPPE-Ⅱ评分对早期识别BPD发生的高危儿具有一定价值。Objective To analyze the risk factors of bronchopulmonary dysplasia(BPD)in extremely low birth weight infants(ELBWI)with gestational age<32 weeks,and to explore the value of Score for Neonatal Acute Physiology Perinatal Extension II(SNAPPE-Ⅱ)in predicting the development of BPD.Methods The clinical data of 106 extremely low birth weight infants with gestational age<32 weeks were admitted to the Neonatal Intensive Care Unit(NICU)of the First Affiliated Hospital of Anhui Medical University from January 2015 to October 2020 were analyzed retrospectively.These infants were divided into BPD group(75 cases)and non-BPD group(31 cases)according to BPD diagnostic criteria.All infants were evaluated with Score for Neonatal Acute Physiology Perinatal Extension II during the first 12 hours of admission.Univariate analysis and multivariate logistic regression analysis were used to screen the risk factors of BPD in extremely low birth weight infants with gestational age<32 weeks.ROC curve was used to analyze the value of Score for Neonatal Acute Physiology Perinatal Extension II in predicting BPD.Results The gestational age in BPD group was significantly shorter than that in non-BPD group(P<0.05).The incidences of antenatal steroid administration,neonatal pneumonia,time of premature rupture of membranes≥18 hours and SNAPPE-Ⅱin BPD group were significantly higher than those in non-BPD group(all P<0.05).Compared with non-BPD group,the duration of mechanical ventilation and hospital stay were longer in BPD group(all P<0.05).Multivariate Logistic regression revealed that gestational age,the time of mechanical ventilation and SNAPPE-Ⅱwere risk factors for BPD in extremely low birth weight infants with gestational age<32 weeks(all P<0.05).The area under ROC curve of SNAPPE-Ⅱfor predicting BPD was 0.778.The cut-off value was 27.0 with sensitivity of 66.7%and specificity of 77.4%.Conclusions For infants with extremely low birth weight and gestational age<32 weeks,the younger the gestational age,the higher score of SNAPPE-Ⅱ

关 键 词：早产 超低出生体质量 支气管肺发育不良 新生儿急性生理学评分围产期补充Ⅱ 

分 类 号：R722.6[医药卫生—儿科]