早产儿支气管肺发育不良合并代谢性骨病的影响因素  

Influencing factors of bronchopulmonary dysplasia complicated with metabolic bone disease in preterm infants

作　　者：杨萍[1] 许世敏 李亮亮[1] 尹向云[1] 锡洪敏[1] 马丽丽[1] 李向红[1] Yang Ping;Xu Shimin;Li Liangliang;Yin Xiangyun;Xi Hongmin;Ma Lili;Li Xianghong(Neonatal Intensive Care Unit,The Affiliated Hospital of Qingdao University,Qingdao 266555,Shandong Province,China)

机构地区：[1]青岛大学附属医院新生儿科,青岛266555

出　　处：《中华妇幼临床医学杂志（电子版）》2023年第2期202-211,共10页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：山东省医药卫生科技发展计划项目(2016WS0278)。

摘　　要：目的探讨早产儿支气管肺发育不良(BPD)合并代谢性骨病(MBD)的临床高危因素。方法选取青岛大学附属医院新生儿重症监护病房(NICU)于2018年1月1日至2020年12月31日收治的151例BPD早产儿为研究对象,按照BPD早产儿是否合并MBD,将其分为BPD合并MBD组(n=41)和单纯BPD组(n=110)。采取回顾性分析法,对2组患儿的临床病例资料、除MBD外的其他并发症发生情况、无创正压通气与有创机械通气治疗时间、药物治疗情况、血清生化指标、肠内与肠外营养情况等进行分析。采用Pearson列联系数,对2组患儿的BPD严重程度与MBD相关性进行分析。再将单因素分析中有统计学意义的变量,纳人多因素非条件logistic回归分析,探讨BPD早产儿合并MBD的影响因素。本研究遵循的研究程序经青岛大学附属医院医学伦理委员会审批(QYFYWZLL26771),并与所有患儿监护人签署书面知情同意书。结果①BPD合并MBD组患儿出生胎龄、出生体重,均低于单纯BPD组,并且差异有统计学意义(P<0.05)。②BPD合并MBD组早产儿无创正压通气时间和住院时间,均长于单纯BPD组,并且差异有统计学意义(P<0.05);BPD合并MBD组患儿住院期间新生儿败血症和新生儿坏死性小肠结肠炎(NEC)发生率,均高于单纯BPD组,并且差异亦有统计学意义(P<0.05)。③2组患儿生后第1、21天时,25-羟维生素D[25(OH)D]浓度、血清碱性磷酸酶(ALP)及血磷水平比较,差异均有统计学意义(P<0.05)。BPD合并MBD组的患儿肠外营养时间和母乳喂养时间与达全肠内喂养日龄,均长于单纯BPD组,并且差异均有统计学意义(P<0.05);BPD合并MBD组生后第28天时,摄人总热量、肠内营养热量、肠内蛋白质及肠外氨基酸,均低于单纯BPD组,并且差异亦均有统计学意义(P<0.05)。③BPD合并MBD患儿的BPD严重程度与MBD呈显著正相关关系(r=0.381,P<0.001)。③BPD早产儿合并MBD影响因素的多因素非条件logistic回归分析结果�Objective To investigate the risk factors for bronchopulmonary dysplasia(BPD)combined with metabolic bone disease(MBD)in premature infants.Methods A total of 151 preterm infants with BPD admitted to Neonatal Intensive Care Unit(NICU)of the Affiliated Hospital of Qingdao University from January 1,2018 to December 31,2020 were selected into this study.According to whether BPD infants had MBD or not,they were divided into BPD complicated with MBD group(n=41)and BPD alone group(n=110).Retrospective analysis was performed to analyze the clinical case data,the occurrence of other complications except MBD,the treatment time of non-invasive positive pressure ventilation and invasive mechanical ventilation,drug treatment,serum biochemical indexes,enteral and parenteral nutrition between two groups.Pearson column correlation number was used to analyze the correlation between the severity of BPD and MBD between two groups.The statistically significant variables in the univariate analysis were included in the multivariate unconditional logistic regression analysis to explore influencing factors of BPD combined with MBD in preterm infants.The research procedures followed in this study were approved by the Medical Ethics Committee of the Affiliated Hospital of Qingdao University(QYFY WZLL 26771),and written informed consents were obtained from all guardians of the children.Results①The gestational age and birth weight of BPD complicated with MBD group were lower than those of BDP alone group,and the differences were statistically significant(P<0.05).②The duration of non-invasive positive pressure ventilation and hospital stay of BPD complicated with MBD group were both longer than those in BPD alone group,and the difference was statistically significant(P<0.05).The incidence of neonatal sepsis and neonatal necrotizing enterocolitis(NEC)in BPD complicated with MBD group during hospitalization were higher than those in BPD alone group,and the difference were statistically significant(P<0.05).③There were statistically signif

关 键 词：支气管肺发育不良 骨疾病 代谢性 碱性磷酸酶 胃肠外营养 危险因素 保护因素 婴儿 早产 

分 类 号：R722.6[医药卫生—儿科]