维生素D与早产儿代谢性骨病合并急性呼吸窘迫综合征撤机困难的相关性研究  

Correlation between vitamin D nutritional status and difficulty weaning preterm infants in metabolic bone disease of prematurity complicated with acute respiratory distress syndrome

作　　者：王松涛[1] 胡莹莹[1] 张俊霞 张宝林[1] Wang Songtao;Hu Yingying;Zhang Junxia;Zhang Baolin(Department of Pediatrics,Binzhou Central Hospital,Binzhou,Shandong 257100)

机构地区：[1]滨州市中心医院儿科,山东滨州257100

出　　处：《中国妇幼健康研究》2023年第5期1-7,共7页Chinese Journal of Woman and Child Health Research

摘　　要：目的 探讨维生素D营养状况与早产儿代谢性骨病(MBDP)合并急性呼吸窘迫综合征(ARDS)机械通气治疗撤机困难的相关性。方法 回顾性收集2019年1月至2021年12月滨州市中心医院收治的89例MBDP合并ARDS早产儿的临床资料,根据患儿的血清25羟维生素D[25(OH)D]水平,将其分为维生素D正常组12例、维生素D不足组35例、维生素D缺乏组42例;所有患儿均接受气管插管机械通气治疗,再以撤机结局分为撤机成功组60例、撤机失败组29例;分析影响撤机结局的因素及血清25(OH)D水平预测MBDP合并ARDS撤机结局的价值。结果 不同维生素D水平三组患儿的胎龄(F=5.211)、出生体重(F=52.423)、机械通气时间(F=27.298)、入院至SBT时间(F=30.942)、住院时间(F=9.793),血清P^(3-)(F=11.460)、ALP(F=23.534)、IL-6(F=26.754)、TNF-α(F=58.812)、CRP(F=21.932)水平,以及坏死性小肠结肠炎发生率(χ^(2)=8.054)、支气管肺发育不良发生率(χ^(2)=10.807)、SBT成功率(χ^(2)=14.688)、撤机成功率(χ^(2)=15.816)比较差异均有统计学意义(P<0.05)。撤机失败组的血清25(OH)D水平显著低于撤机成功组(t=4.623,P<0.05),支气管肺发育不良发生率显著高于撤机成功组(χ^(2)=10.005,P<0.05);机械通气时间(t=8.833)、入院至SBT时间(t=8.874)、住院时间(t=3.439),以及血清IL-6(t=10.642)、TNF-α(t=10.826)、CRP(t=6.995)水平均显著高于撤机成功组(P<0.05)。合并支气管肺发育不良(OR=2.277,95%CI:1.384~3.747)、机械通气时间(OR=2.065,95%CI:1.382~3.086)、入院至SBT时间(OR=1.887,95%CI:1.316~2.706)、血清IL-6(OR=1.701,95%CI:1.158~2.497)均是MBDP合并ARDS撤机失败的危险因素(P<0.05),血清25(OH)D水平高是MBDP合并ARDS撤机失败的保护因素(OR=0.414,95%CI:0.273~0.625,P<0.05)。血清25(OH)D水平预测MBDP合并ARDS撤机失败的曲线下面积(AUC)为0.782(95%CI:0.681~0.862),灵敏度为75.86%,特异度为85.00%,P<0.05。结论 早产儿出生时维生素D缺乏可延长MBDP合并ARDS机械通�Objective To investigate the relationship between vitamin D nutritional status and difficulty weaning in preterm infants with metabolic bone disease of prematurity(MBDP) complicated with acute respiratory distress syndrome(ARDS).Methods The clinical data of 89 preterm infants with MBDP complicated with ARDS and admitted to the Binzhou Central Hospital from January 2019 to December 2021 were retrospectively collected.According to the serum 25-hydroxy vitamin D [25(OH)D] level, they were divided into 12 cases of the normal vitamin D group, 35 cases of the vitamin D inadequate group, and 42 cases of the vitamin D deficiency group.All children received mechanical ventilation through endotracheal intubation, and they were divided into the weaning success group with 60 cases and the weaning failure group with 29 cases according to the weaning status.The factors influencing weaning outcomes and the value of serum 25(OH)D in predicting weaning outcomes of MBDP complicated with ARDS were analyzed.Results There were statistically significant differences in gestational age(F=5.211),birth weight(F=52.423),duration of mechanical ventilation(F=27.298),time from admission to SBT(F=30.942),duration of hospital stay(F=9.793),serum P^(3-)(F=11.460),ALP(F=23.534),IL-6(F=26.754),TNF-α(F=58.812),CRP(F=21.932) levels, and the incidences of necrotizing enterocolitis(χ^(2)=8.054),bronchopulmonary dysplasia(χ^(2)=10.807),SBT success rate(χ^(2)=14.688) and weaning success rate(χ^(2)=15.816) among the three groups with different vitamin D levels(P<0.05).Compared with the weaning success group, the 25(OH)D level was lower(t=4.623,P<0.05),the incidence of bronchopulmonary dysplasia was higher(χ^(2)=10.005,P<0.05),duration of mechanical ventilation(t=8.833),time from admission to SBT(t=8.874),duration of hospital stay(t=3.439),and levels of IL-6(t=10.642),TNF-α(t=10.826) and CRP(t=6.995) were higher in the weaning failure group(P<0.05).Complicated with bronchopulmonary dysplasia(OR=2.277,95%CI:1.384-3.747),duration of mechanical ventil

关 键 词：代谢性骨病 呼吸窘迫综合征 早产儿 机械通气 撤机 

分 类 号：R174[医药卫生—妇幼卫生保健]