早产儿NRDS不良结局的危险因素及列线图模型构建  

Risk factors and nomogram model for adverse NRDS outcomes in preterm infants

作　　者：张洁 蒋鹤飞 方玲 胡瑞[2] 陈君君[1] 沈婧 刘腾 ZHANG Jie;JIANG Hefei;FANG Ling;HU Rui;CHEN Junjun;SHEN Jing;LIU Teng(Anqing Medical College,Anqing 246052,Anhui,China;Anqing Municipal Hospital,Anqing 246004,Anhui,China)

机构地区：[1]安庆医药高等专科学校,安徽安庆246052 [2]安徽省安庆市立医院,安徽安庆246004

出　　处：《右江民族医学院学报》2024年第4期547-552,共6页Journal of Youjiang Medical University for Nationalities

基　　金：安徽省高校科学研究项目(重点)(SK2020A0678)。

摘　　要：目的通过对早产儿发生新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)的不良结局进行危险因素的识别并构建列线图模型,为减少早产儿NRDS发生不良结局提供理论依据。方法对453例早产儿NRDS患儿进行分析,分为结局不良组和结局良好组,采用单因素和多因素Logistic回归分析并构建列线图模型。结果单因素分析中早产类别、出生体重、胎龄与体重关系、肺动脉高压、NEC/消化道出血、败血症、肺出血、乳酸脱氢酶、pH、剖宫产、瘢痕子宫、通气方式、用肺表面活性物质(PS)次数、无创通气天数、有创通气天数、白蛋白使用差异性具有统计学意义(P<0.05);多因素Logistic回归分析显示早产类别、胎龄与体重关系、肺动脉高压、NEC/消化道出血、肺出血、乳酸脱氢酶和无创通气天数为患儿发生不良结局的影响因素,建立患儿发生结局不良的风险预测列线图模型;采用ROC曲线和校准曲线评估列线图模型对患儿发生不良结局的预测价值和效能。结论极早/早期早产儿、小于胎龄儿、肺动脉高压、NEC/消化道出血、肺出血、乳酸脱氢酶增高是早产儿NRDS预后不良的危险因素,根据风险列线图可以预测早产儿NRDS发生不良结局的风险,提前进行干预,减少不良结局的发生率。Objective To identify the risk factors for adverse outcomes of neonatal respiratory distress syndrome(NRDS)in preterm infants and construct a nomogram model.The findings will provide a theoretical basis for reducing adverse NRDS outcomes in this vulnerable population.Methods 453 preterm infants with NRDS were analyzed and divided into poor and good outcome groups.Univariate analysis and multivariate logistic regression were used to establish a nomogram model.Results Univariate analysis revealed statistically significant differences(P<0.05)in several factors,including preterm birth category,birth weight,gestational age-weight relationship,pulmonary hypertension,necrotizing enterocolitis(NEC)/digestive tract hemorrhage,sepsis,pulmonary hemorrhage,lactate dehydrogenase levels,pH,cesarean section,cicatricial uterus,ventilation mode,pulmonary surfactant(PS)usage,duration of non-invasive and invasive ventilation,and albumin use.Multivariate logistic regression analysis identified the following influential factors for adverse outcomes:preterm birth category,gestational age-weight relationship,pulmonary hypertension,NEC/digestive tract hemorrhage,pulmonary hemorrhage,lactate dehydrogenase levels,and duration of non-invasive ventilation.Based on these factors,we developed a nomogram model for risk prediction of adverse outcomes.Receiver operating characteristic(ROC)curve and calibration curves were used to evaluate predictive value and efficacy of the nomogram model.Conclusion Several factors contribute to poor NRDS prognosis in preterm infants.These include very preterm/early preterm birth,small-for-gestational-age infants,pulmonary hypertension,NEC/digestive tract hemorrhage,pulmonary hemorrhage,and elevated lactate dehydrogenase levels.The risk of adverse NRDS outcomes in preterm infants can be predicted according to the risk column diagram,enabling early intervention to reduce the incidence of adverse outcomes.

关 键 词：早产儿 呼吸窘迫综合征 新生儿 不良结局 危险因素 列线图模 

分 类 号：R722.12[医药卫生—儿科]