341例极早产儿/极低出生体重儿支气管肺发育不良的临床特点及危险因素  

Clinical characteristics and risk factors of 341 very preterm/very low birth weight infants with bronchopulmonary dysplasia

作　　者：谷萍姣 戴怡蘅[1] 叶旭强[1] 石计朋 Gu Pingjiao;Dai Yiheng;Ye Xuqiang;Shi Jipeng(Department of Neonatology,Foshan Women and Children Hospital Affiliated to Southern Medical University,Foshan 528000,China)

机构地区：[1]南方医科大学附属佛山市妇幼保健院新生儿科,佛山528000

出　　处：《中国医师杂志》2023年第4期565-569,共5页Journal of Chinese Physician

基　　金：佛山市卫生健康局医学科研课题(20210010)。

摘　　要：目的探讨极早产儿/极低出生体重儿支气管肺发育不良(BPD)的临床特点,了解BPD发生的危险因素。方法回顾性分析2019年1月至2020年12月在佛山市妇幼保健院出生并于生后24 h内入住该院新生儿重症监护病房(NICU)、胎龄在23^(+0)~31^(+6)周或出生体重<1500 g的早产儿临床数据,共纳入研究对象341例,按临床诊断分为非BPD组和BPD组,分析BPD患儿的临床特点,构建二分类logistic回归模型分析BPD发生的危险因素。结果341例患儿中,非BPD组255例,BPD组86例,BPD总发生率25.2%,胎龄<30周、30~32周、>32周新生儿BPD发生率分别为43.8%(63/144)、15.1%(22/146)、2.0%(1/51);出生体重<1000 g、1000~1499 g、≥1500 g新生儿BPD发生率分别为80.0%(36/45)、20.2%(41/203)、9.7%(9/93)。BPD组患儿出生胎龄、体重、剖宫产出生率及7 d内拔管率均低于非BPD组[(28.5±2.4)周vs(30.7±1.8)周、(1087.9±312.8)g vs(1418.4±247.9)g、54.6%(47/86)vs 75.7%(193/255)、57.1%(44/77)vs 90.0%(108/120),均P<0.05];与非BPD组相比,BPD组患儿出生5 min Apgar评分≤7分占比[16.3%(14/86)vs 2.4%(6/255)]、气管插管率[62.8%(54/86)vs 27.4%(70/255)]、红细胞输注≥3次占比[31.4%(27/86)vs 6.3%(16/255)]、肺表面活性物质(PS)使用率[82.6%(71/86)vs 44.7%(114/255)]、机械通气比例[89.5%(77/86)vs 47.0%(120/255)]、合并有血流动力学意义的动脉导管未闭(HsPDA)[34.9%(30/86)vs 8.2%(21/255)]、合并新生儿呼吸窘迫综合征(NRDS)[94.2%(81/86)vs 5.9%(15/255)]、合并临床诊断败血症[17.4%(15/86)vs 7.0%(18/255)]、合并≥3期早产儿视网膜病变(ROP)[20.9%(18/86)vs 2.7%(7/255)]、病死率[10.5%(9/86)vs 0.8%(2/255)]、机械通气时间、用氧持续时间、住院时间均较高(均P<0.05)。多因素logistic回归分析结果显示:出生胎龄小(OR=1.285,95%CI:1.010~1.633)、出生5 min Apgar评分≤7分(OR=5.712,95%CI:1.411~23.115)、机械通气时间长(OR=1.113,95%CI:1.043~1.188)及用氧持续时间长(OR=1.139,95%CI:1.092~1.188)是BPD发生的�Objective To investigate clinical characteristics and potential risk factors of very preterm/very low birth weight infants with bronchopulmonary dysplasia(BPD).Methods A retrospective epidemiological study was performed in 341 neonates with birth weights<1500 g or gestational age between 23^(+0) to 31^(+6) weeks,who were born in Foshan Women and Children Hospital and were admitted to neonatal intensive care units(NICU)within 24 hours of birth.These neonates were divided into non-BPD group and BPD group.Clinical characteristics and potential risk factors were comparatively analyzed between groups.Risk factors for BPD were identified by binary logistic regression analysis.Results Among the total of 341 enrolled neonates,including 255 neonates without BPD and 86 neonates with BPD,the total incidence of BPD was 25.2%.The incidences of BPD in the infants with gestational age of<30 weeks,30-32 weeks,and>32 weeks,as well as birth weight<1000 g,1000-1499 g,and≥1500 g were 43.8%(63/144),15.1%(22/146),2.0%(1/51),80.0%(36/45),20.2%(41/203),9.7%(9/93),respectively.The gestational age,birth weight,the proportion of cesarean section,and extubation rate within 7 days were lower in BPD group than those in non-BPD group[(28.5±2.4)weeks vs(30.7±1.8)weeks,(1087.9±312.8)g vs(1418.4±247.9)g,54.6%(47/86)vs 75.7%(193/255),57.1%(44/77)vs 90.0%(108/120),all P<0.05].Compared to the non-BPD group,the proportion of Apgar score of≤7 points 5 minutes after birth[16.3%(14/86)vs 2.4%(6/255)],postnatal endotracheal intubation rate[62.8%(54/86)vs 27.4%(70/255)],volume of red blood cell transfusion≥3 times[31.4%(27/86)vs 6.3%(16/255)],pulmonary surfactant(PS)utilization[82.6%(71/86)vs 44.7%(114/255)],rate of conventional mechanical ventilation[89.5%(77/86)vs 47.0%(120/255)],combined with hemodynamically significant patent ductus arteriosus(HsPDA)[34.9%(30/86)vs 8.2%(21/255)],diagnosed with neonatal respiratory distress syndrome(NRDS)[94.2%(81/86)vs 5.9%(15/255)],combined with clinically diagnosed sepsis[17.4%(15/86)vs 7.0%(18/255)],combi

关 键 词：婴儿 极度早产 婴儿 极低出生体重 支气管肺发育不良 危险因素 

分 类 号：R722.6[医药卫生—儿科]