超早产儿肺出血临床特点及高危因素研究  

Clinical features and risk factors of pulmonary hemorrhage in extremely preterm infants

作　　者：齐敏 张烨 杨世炳 厉星[2] 姜舟 Qi Min;Zhang Ye;Yang Shibing;Li Xing;Jiang Zhou(Neonatal Intensive Care Unit,Sir Run Run Shaw Hospital,College of Medicine,Zhejiang University,Hangzhou 310016,China;Department of Pharmacy,Sir Run Run Shaw Hospital,College of Medicine,Zhejiang University,Hangzhou 310016,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院新生儿重症监护病房,杭州310016 [2]浙江大学医学院附属邵逸夫医院药学部,杭州310016

出　　处：《中华新生儿科杂志（中英文）》2023年第4期200-204,共5页Chinese Journal of Neonatology

摘　　要：目的探讨超早产儿肺出血的临床特点及高危因素。方法选择2018年2月至2022年1月邵逸夫医院新生儿重症监护病房收治并诊断为肺出血的超早产儿为观察组,同期入院未发生肺出血的超早产儿为对照组,进行回顾性病例对照研究。应用SPSS 25.0统计软件,采用单因素分析和多因素logistic回归分析,比较两组患儿的临床情况、分析超早产儿肺出血的临床特征和高危因素。结果共纳入114例超早产儿,28例(24.6%)诊断肺出血(观察组),主要发生在生后1周内,对照组86例。单因素分析显示,观察组出生窒息、产房插管、严重新生儿呼吸窘迫综合征、高血糖、血小板减少、严重酸中毒、休克、新生儿急性生理学和围产期补充Ⅱ(score for neonatal acute physiology with perinatal extension-Ⅱ,SNAPPE-Ⅱ)评分≥37分比例及最高乳酸值高于对照组,出生体重小于对照组,差异有统计学意义(P<0.05)。logistic回归分析显示,SNAPPE-Ⅱ评分≥37分、休克、高血糖是超早产儿发生肺出血的危险因素(OR值分别为4.081、4.610、3.355,P<0.05)。观察组死亡率和颅内出血发生率高于对照组,机械通气时间长于对照组,差异有统计学意义(P<0.05);两组经鼻持续气道正压通气时间、辅助通气及总用氧时间、Ⅱ~Ⅲ级支气管肺发育不良及早产儿视网膜病发生率、住院时间比较,差异均无统计学意义(P>0.05)。结论对于SNAPPE-Ⅱ评分≥37分、休克、高血糖的超早产儿,早期应警惕肺出血的发生,肺出血患儿死亡率和颅内出血发生率更高,需要机械通气的时间更长。Objective To study the clinical features and risk factors of pulmonary hemorrhage in extremely preterm(EPT)infants.Methods From February 2018 to January 2022,EPT infants admitted to NICU of our hospital and diagnosed with pulmonary hemorrhage were retrospectively assigned into the observation group and those without pulmonary hemorrhage were assigned into the control group.Univariate analysis and multivariate logistic regression analysis were used to compare the clinical features and determine risk factors of pulmonary hemorrhage in EPT infants.Results A total of 114 EPT infants were included,including 28 cases(24.6%)in the observation group with pulmonary hemorrhage and 86 cases in the control group.Pulmonary hemorrhage mainly occurred within the first week after birth.Univariate analysis showed that the observation group had higher incidences of following events than the control group:birth asphyxia,delivery room intubation,severe respiratory distress syndrome,hyperglycemia,thrombocytopenia,severe acidosis,shock,score for neonatal acute physiology with perinatal extension-Ⅱ(SNAPPE-Ⅱ)≥37 and the highest lactate level.Birth weight was lower in the observation group than the control group(P<0.05).Logistic regression analysis showed that SNAPPE-Ⅱ≥37,shock and hyperglycemia were risk factors of pulmonary hemorrhage(OR=4.081,4.610 and 3.355,respectively,all P<0.05).The incidences of mortality and intracranial hemorrhage in the observation group were higher than the control group.The duration of mechanical ventilation in the observation group was longer than the control group(P<0.05).No significant differences existed in the duration of nasal continuous positive airway pressure,assist mechanical ventilation and total oxygen use,the incidences of gradeⅡ-Ⅲbronchopulmonary dysplasia,retinopathy of prematurity and the length of hospital stay(P>0.05).Conclusions SNAPPE-Ⅱ≥37,shock and hyperglycemia are early risk factors for pulmonary hemorrhage in EPT infants.EPT infants with pulmonary hemorrhage have hig

关 键 词：肺出血 早产儿 危险因素 

分 类 号：R722.6[医药卫生—儿科]