极早产儿支气管肺发育不良危险因素的全国多中心研究  

Risk factors of bronchopulmonary dysplasia in very preterm infants:a national multicenter study

作　　者：巴瑞华 唐丽霞[1] 沈蔚 王恋 郑直 林新祝 吴繁[2] 田倩欣 崔其亮[2] 袁媛[3] 任玲 毛健[3] 王玉梅 石碧珍 刘玲 张京慧 常艳美[5] 童笑梅[5] 朱燕[6] 张蓉[6] 叶秀桢[7] 邹静静[7] 李怀玉[8] 赵宝银 邱银萍[8] 刘淑华[9] 马莉[9] 徐颖 程锐[10] 周文莉[11] 武辉[11] 刘志勇 陈冬梅 高金枝 刘晶[13] 陈玲[13] 李丛[14] 杨春燕[14] 许平 张亚昱[15] 呼斯乐 梅花[15] 杨祖铭[16] 冯宗太[16] 王三南[16] 孟二艳 尚利宏[17] 徐发林[17] 欧少苹 巨容 中国医师协会新生儿科医师分会营养专业委员会全国多中心EUGR协作组 Ba Ruihua;Tang Lixia;Shen Wei;Wang Lian;Zheng Zhi;Lin Xinzhu;Wu Fan;Tian Qianxin;Cui Qiliang;Yuan Yuan;Ren Ling;Mao Jian;Wang Yumei;Shi Bizhen;Liu Ling;Zhang Jinghui;Chang Yanmei;Tong Xiaomei;Zhu Yan;Zhang Rong;Ye Xiuzhen;Zou Jingjing;Li Huaiyu;Zhao Baoyin;Qiu Yinping;Liu Shuhua;Ma Li;Xu Ying;Cheng Rui;Zhou Wenli;Wu Hui;Liu Zhiyong;Chen Dongmei;Gao Jinzhi;Liu Jing;Chen Ling;Li Cong;Yang Chunyan;Xu Ping;Zhang Yayu;Hu Sile;Mei Hua;Yang Zuming;Feng Zongtai;Wang Sannan;Meng Eryan;Shang Lihong;Xu Falin;Ou Shaoping;Ju Rong;National Multicenter EUGR Collaborative Group,Nutritional Committee of Neonatology Branch of Chinese Medical Doctor Association(Department of Neonatology,Women and Children′s Hospital,School of Medicine,Xiamen University,Xiamen 361003,China;Department of Neonatology,the Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510150,China;Department of Pediatrics,Shengjing Hospital of China Medical University,Shenyang 110004,China;Department of Neonatology,Guiyang Maternal and Child Health Hospital,Guiyang Children′s Hospital,Guiyang 550002,China;Department of Pediatrics,Peking University Third Hospital,Beijing 100191,China;Department of Neonatology,Children′s Hospital of Fudan University,Shanghai 201102,China;Department of Neonatology,Guangdong Province Maternal and Children′s Hospital,Guangzhou 510030,China;Department of Neonatology,General Hospital of Ningxia Medical University,Yinchuan 750001,China;Department of Neonatology,Children′s Hospital of Hebei Province,Shijiazhuang 050031,China;Department of Neonatology,Children′s Hospital of Nanjing Medical University,Nanjing 210000,China;Department of Neonatology,the First Hospital of Jilin University,Changchun 130000,China;Department of Neonatology,Quanzhou Maternity and Children′s Hospital,Quanzhou 362000,China;Department of Pediatrics,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430000,China;Department of Neonatology,Liaocheng People′s Hospital,Liaocheng 252000,China;Department

机构地区：[1]厦门大学附属妇女儿童医院/厦门市妇幼保健院,361003 [2]广州医科大学附属第三医院儿科,510150 [3]中国医科大学附属盛京医院,沈阳110004 [4]贵阳市妇幼保健院,贵阳市儿童医院,550002 [5]北京大学第三医院,100191 [6]复旦大学附属儿科医院,上海201102 [7]广东省妇幼保健院,广州5100308 [8]宁夏医科大学总医院,银川750001 [9]河北省儿童医院,石家庄050031 [10]南京医科大学附属儿童医院,210000 [11]吉林大学第一医院,长春130000 [12]泉州市妇幼保健院儿童医院,362000 [13]华中科技大学同济医学院附属同济医院,武汉430000 [14]山东省聊城市人民医院252000 [15]内蒙古医科大学附属医院,呼和浩特010010 [16]苏州市立医院,215002 [17]郑州大学第三附属医院(河南省妇幼保健院),450052 [18]电子科技大学医学院附属妇女儿童医院,成都市妇女儿童中心医院,611731 [19]不详

出　　处：《中国小儿急救医学》2022年第6期433-439,共7页Chinese Pediatric Emergency Medicine

基　　金：厦门市医疗卫生指导性项目(3502Z20214ZD1225)。

摘　　要：目的分析极早产儿(VPI)发生支气管肺发育不良(BPD)的危险因素,为防治VPI BPD提供科学依据。方法采用前瞻性多中心研究方法,收集国内7个地区28家医院新生儿科2019年9月至2020年12月收治VPI的临床资料,根据生后28 d是否持续氧依赖分为无BPD组和BPD组,分析VPI发生BPD的危险因素。结果纳入符合标准的VPI 2514例,无BPD组1364例,BPD组1150例,BPD发病率45.7%;出生胎龄、体重越小,BPD发病率越高(P均<0.001)。与无BPD组比较,BPD组患儿平均出生胎龄、体重、剖宫产率较低,男婴、小于胎龄儿、5 min Apgar评分≤7分发病率较高(P均<0.01)。BPD组新生儿呼吸窘迫综合征(NRDS)、合并血流动力学改变的动脉导管未闭、需干预的早产儿视网膜病、喂养不耐受、宫外生长发育迟缓、Ⅲ~Ⅳ级颅内出血、贫血、早发和晚发败血症、院内感染、静脉营养相关性胆汁淤积症发病率较高(P均<0.05),肺表面活性物质使用、激素暴露、贫血且需输血的比例较高,有创和无创机械通气时间、用氧时间及总住院时间较长(P均<0.001)。BPD组的开始肠内营养时间、累计禁食天数、达全肠内营养日龄、肠外营养持续天数、总热卡达110 kcal/(kg·d)日龄、口服热卡达110 kcal/(kg·d)日龄均大于无BPD组,母乳喂养率低于无BPD组(P均<0.001)。住院第1周氨基酸、脂肪乳累计剂量BPD组较高(P均<0.001)。多因素Logistic回归分析显示,NRDS、有创机械通气、达全肠内营养日龄、贫血且需输血是VPI发生BPD的独立危险因素,出生胎龄较大是BPD的保护因素。结论加强围生期管理,避免早产和严重NRDS发生,缩短有创机械通气时间,重视肠内营养管理,尽快达全肠道喂养,严格掌握输血指征,对于降低VPI BPD的发病率至关重要。Objective To analyze the risk factors of bronchopulmonary dysplasia(BPD)in very preterm infants(VPI),and to provide scientific basis for the prevention and treatment of BPD in VPI.Methods A prospective multicenter study was designed to collect the clinical data of VPI in department of neonatology of 28 hospitals in 7 regions from September 2019 to December 2020.According to the continuous oxygen dependence at 28 days after birth,VPI were divided into non BPD group and BPD group,and the risk factors of BPD in VPI were analyzed.Results A total of 2514 cases of VPI including 1364 cases without BPD and 1150 cases with BPD were enrolled.The incidence of BPD was 45.7%.The smaller the gestational age and weight,the higher the incidence of BPD(P<0.001).Compared with non BPD group,the average birth age,weight and cesarean section rate in BPD group were lower,and the incidence of male infants,small for gestational age and 5-minute apgar score≤7 were higher(P<0.01).In BPD group,the incidences of neonatal respiratory distress syndrome(NRDS),hemodynamically significant patent ductus arteriosus,retinopathy of prematurity,feeding intolerance,extrauterine growth restriction,gradeⅢ~Ⅳintracranial hemorrhage,anemia,early-onset and late-onset sepsis,nosocomial infection,parenteral nutrition-associated cholestasis were higher(P<0.05),the use of pulmonary surfactant(PS),postnatal hormone exposure,anemia and blood transfusion were also higher,and the time of invasive and non-invasive mechanical ventilation,oxygen use and total hospital stay were longer(P<0.001).The time of starting enteral nutrition,cumulative fasting days,days of reaching total enteral nutrition,days of continuous parenteral nutrition,days of reaching 110 kcal/(kg·d)total calorie,days of reaching 110 kcal/(kg·d)oral calorie were longer and the breastfeeding rate was lower in BPD group than those in non BPD group(P<0.001).The cumulative doses of amino acid and fat emulsion during the first week of hospitalization were higher in BPD group(P<0.001).Multivariate L

关 键 词：极早产儿 支气管肺发育不良 发生率 肠内营养 危险因素 

分 类 号：R722.6[医药卫生—儿科]