胎龄小于32周的极/超低出生体质量儿支气管肺发育不良及严重程度危险因素分析  

Analysis of risk factors of bronchopulmonary dysplasia and itsseverity in very/extremely low birth weight infants with gestational age less than 32 weeks

作　　者：朱克然[1] 周登余[1] 王琍琍[1] ZHU Keran;ZHOU Dengyu;WANG Lili(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新生儿科,合肥安徽230022

出　　处：《安徽医学》2021年第12期1371-1376,共6页Anhui Medical Journal

摘　　要：目的研究影响胎龄小于32周的极/超低出生体质量儿支气管肺发育不良及其严重程度的危险因素,为新生儿临床工作提供帮助。方法选取2019年1月至2021年1月于安徽医科大学第一附属医院新生儿科住院超过28天的130例胎龄小于32周的极/超低出生体质量儿,根据支气管肺发育不良诊断标准分为支气管肺发育不良(BPD)组54例和非支气管肺发育不良(nBPD)组76例;其中54例BPD早产儿,根据BPD诊断标准分为轻度BPD组43例、中重度BPD组11例。分析该130例患儿的围产期因素,其中孕母因素包括是否使用产前激素、生产方式、是否多胎、是否为初产妇、产妇年龄、是否合并相关疾病如重度子痫前期、绒毛膜羊膜炎、阴道流液、产前发热、胎膜早破;新生儿因素包括胎龄、出生体质量、Apgar评分、性别、首选通气方式、机械通气时间及是否使用INSURE技术。对各组间有统计学差异的因素,采用logistic回归分析探究影响患儿BPD及其严重程度的危险因素。结果logistic分析提示,胎龄越小(OR=0.110,95%CI:0.007~0.638)、机械通气时间越长(OR=2.178,95%CI:1.046~4.534)、用氧时间越长(OR=1.635,95%CI:1.148~2.327)和未采用INSURE技术(OR=0.006,95%CI:0.000~0.972)是患儿发生BPD的危险因素。机械通气时间越长(OR=1.567,95%CI:1.228~1.720)、用氧时间越长(OR=1.358,95%CI:1.009~1.828)是患儿BPD严重程度的危险因素。结论胎龄小、未采用INSURE技术、机械通气时间及用氧时间长是患儿发生BPD的危险因素;机械通气时间和用氧时间越长是患儿BPD严重程度的危险因素。因此,对于胎龄小于32周的极/超低出生体质量儿,应首选INSURE技术及无创通气,减少机械通气及用氧时间。Objective To investigate the risk factors of bronchopulmonary dysplasia and its severity in very/extremely low birth weight infants with gestational age less than 32 weeks,in order to provide help for clinical work of neonates.Methods From January 2019 to January 2021,130 very/extremely low birth weight infants with gestational age less than 32 weeks who were hospitalized for more than 28 days in the Department of Neonatology of the First Affiliated Hospital of Anhui Medical University were selected.According to the diagnostic criteria of bronchopulmonary dysplasia,54 cases were divided into bronchopulmonary dysplasia(BPD)group and 76 cases were non-bronchopulmonary dysplasia(nBPD)group.According to the diagnostic criteria of BPD,54 BPD patients were divided into mild BPD group(43 cases)and moderate/severe BPD group(11 cases).Perinatal factors of the 130 neonates were analyzed,including maternal factors containing antenatal glucocorticoid use or not,mode of delivery,multiple pregnancies or not,primiparas or not,maternal age,and if complicated with diseases such as severe preeclampsia,chorioamnitis,vaginal fluid,prenatal fever,and premature rupture of membranes or not.Neonatal factors included gestational age,birth weight,Apgar score,gender,initial ventilation method,duration of mechanical ventilation andwhether use intubation surfactant and extubation technique,INSURE technique.Logistics regression analysis was used for analysis the factors of BPD and its severity.Results Logistics analysis indicated that smaller gestational age(OR=0.110,95%CI:0.007~0.638),longer mechanical ventilation time(OR=2.178,95%CI:1.046~4.534),longer oxygen use time(OR=1.635,95%CI:1.148~2.327)and without INSURE technology(OR=0.006,95%CI:0.000~0.972)were the risk factors for BPD.Longer mechanical ventilation time(OR=1.567,95%CI:1.228~1.720)and longer oxygen use time(OR=1.358,95%CI:1.009~1.828)were risk factors for the severity of BPD.Conclusion Small gestational age,without INSURE technology,long mechanical ventilation and oxygen usetime a

关 键 词：极/超低出生体质量儿 支气管肺发育不良 机械通气时间 INSURE技术 用氧时间 

分 类 号：R722.1[医药卫生—儿科]