极早和超早产儿支气管肺发育不良的回顾性研究  

Retrospective study of bronchopulmonary dysplasia in very preterm infants and extremely preterm infants

作　　者：沈仙[1] 陈许[1] 卢刻羽 朱雯[1] 陆亚东[1] 程锐[1] 莫绪明[2] SHEN Xian;CHEN Xu;LU Keyu;ZHU Wen;LU Yadong;CHENG Rui;MO Xuming(Department of Neonatology,Children’s Hospital of Nanjing Medical University,Nanjing 210008,China;Depa6rtment of Cardiothoracic Surgery Children’s Hospital of Nanjing Medical University,Nanjing 210008,China)

机构地区：[1]南京医科大学附属儿童医院新生儿医疗中心,江苏南京210008 [2]南京医科大学附属儿童医院心胸外科,江苏南京210008

出　　处：《南京医科大学学报（自然科学版）》2022年第10期1440-1445,共6页Journal of Nanjing Medical University(Natural Sciences)

基　　金：南京市医学科技发展项目(YKK17157)。

摘　　要：目的:分析并总结本新生儿重症监护室(neonatal intensive care unit,NICU)极早和超早产儿的救治现状及支气管肺发育不良(bronchopulmonary dysplasia,BPD)发病情况。方法:回顾性分析2018年1月—2020年12月南京医科大学附属儿童医院新生儿医疗中心收治的胎龄<32周且出院日龄≥28 d共547例早产儿的临床资料,按临床诊断分为BPD组(n=126)和非BPD组(n=421),综合比较两组早产儿的情况,并纵向分析、总结3年的临床资料及BPD情况。结果:BPD组胎龄为(28.57±1.49)周,胎龄<28周的超早产儿占31.7%,而非BPD组胎龄为(30.05±1.39)周,超早产儿仅占8.1%(P<0.05)。BPD组出生体重(1132.18±251.25)g,<1000 g的超低出生体重儿占28.6%,而非BPD组出生体重(1384.47±267.44)g,超低出生体重儿仅占6.4%(P<0.05)。BPD组5 min Apgar评分≤7分、产房复苏率均升高(P<0.05)。非BPD组使用肺表面活性物质(pulmonary surfactant,PS)者第1次使用剂量显著大于BPD组(P<0.05),≥2次使用率低于BPD组(P<0.01)。BPD组有创及无创通气比例、通气持续时间及肺出血发病率均显著升高(P均<0.001),住院时间及总费用均高于非BPD组(P<0.05)。纵向分析,3年BPD总发病率为23.0%,2019年最高(28.8%),2018年最低(15.3%),差异有统计学意义(P<0.05);有创机械通气比例、超早产儿及超低出生体重儿比例均无显著差异(P>0.05),但2018年超低出生体重儿的平均体重显著高于其他年份(P<0.05)。结论:应加强对超早产儿及超低出生体重儿早期病情的监测及跟踪,重视PS的早期规范化应用,以进一步减少BPD,改善临床预后。Objective:To analyze and summarize the treatment status and the incidence of bronchopulmonary dysplasia(BPD)in very preterm infants(VPI)and extremely preterm infants(EPI)in the latest 3 years.Methods:A retrospective analysis was performed in 547 premature infants,with gestational age less than 32 weeks and survival time≥28 days,who were admitted to Neonatal Medical Center of Children’s Hospital of Nanjing Medical University from January 2018 to December 2020.According to clinical diagnosis,they were divided into BPD group(n=126)and non-BPD group(n=421).The two groups were compared comprehensively,and the clinical data and incidence of BPD among the latest 3 years were compared and summarized.Results:The gestational age of the BPD group was 28.57±1.49 weeks,and the EPI with gestational age less than 28 weeks accounted for 31.7%,while that of the non-BPD group was 30.05±1.39 weeks,and the EPI was only 8.1%(P<0.05).The birth weight of BPD group was 1132.18±251.25 g,and the extremely low birth weight(ELBW)infants with birth weight<1000 g accounted for 28.6%,while that of non-BPD group was1384.47±267.44 g,and ELBW infants only accounted for 6.4%(P<0.05).The proportion of 5 min Apgar score≤7 and resuscitation in the delivery room were significantly higher in BPD group(P<0.05).The first dose of the pulmonary surfactant was significantly higher(P<0.05)and the rate of usage times≥2 times was lower(P<0.01)in the non-BPD group.The the proportion of invasive mechanical ventilation and non-invasive ventilation,duration of ventilation and incidence of pulmonary hemorrhage were significantly increased in BPD group(P<0.001).The length of hospitalization was significantly longer and total cost was higher in BPD group(P<0.05).Longitudinal analysis showed the total incidence of BPD was 23.0%in three years,while it was 28.8%in 2019 and 15.3%in 2018(P<0.05),there were no significant differences in the proportion of invasive mechanical ventilation,EPI and ELBW(P>0.05),but the ELBW in 2018 was significantly higher than othe

关 键 词：支气管肺发育不良 超早产儿 极早产儿 超低出生体重儿 

分 类 号：R722.1[医药卫生—儿科]