极低出生体重儿肺出血预测模型的建立  

A prediction model for pulmonary hemorrhage in very low birth weight infants

作　　者：吴卫月 陈金玉 王琍琍[1] WU Weiyue;CHEN Jinyu;WANG Lili(Department of Neonatology,the First Affiliated Hospital of Anhui Medical University,Anhui Province,Hefei 230031,China)

机构地区：[1]安徽医科大学第一附属医院新生儿科,安徽合肥230031

出　　处：《妇儿健康导刊》2025年第8期187-192,198,共7页JOURNAL OF WOMEN AND CHILDREN'S HEALTH GUIDE

摘　　要：目的探讨极低出生体重儿(VLBWI)发生肺出血的高危因素并建立预测模型。方法回顾性分析2016年10月至2023年10月安徽医科大学第一附属医院收治的142例VLBWI的临床资料,按照新生儿肺出血诊断标准分为肺出血组(63例)和无肺出血组(79例)。收集两组临床特征、凝血指标、血气分析指标等,先进行单因素分析,再纳入多因素logistic回归分析高危因素,构建预测模型,通过受试者工作特征(ROC)曲线、校准曲线及决策曲线对VLBWI肺出血预测模型进行评估。结果肺出血组和无肺出血组性别、剖宫产、羊水量异常、羊水污染、胎盘异常、脐带异常、人工授精、气管插管等比较,差异无统计学意义(P>0.05);两组出生体重、胎龄、肺表面活性物质(PS)使用、胎膜早破>18 h、产前糖皮质激素使用、低白蛋白血症、1 min Apgar评分、5 min Apgar评分、凝血酶原时间、凝血酶原活动度、国际标准化比值、活化部分凝血活酶时间(APTT)、纤维蛋白原、二氧化碳分压、HCO^(3-)、二氧化碳总量、游离钙(i Ca)比较,差异均有统计学意义(P<0.05)。多因素logistic分析显示,产前糖皮质激素使用、iCa是VLBWI肺出血发生的保护因素,PS使用、APTT是VLBWI肺出血发生的独立危险因素(P<0.05)。4个独立因素纳入最终模型,该模型的ROC曲线下面积为0.811。结论VLBWI肺出血的发生与产妇产前糖皮质激素使用、新生儿出生后PS使用、APTT延长及低iCa相关,利用这些因素构建的预测模型可帮助临床医生早期识别肺出血高危人群,为临床诊疗提供重要的参考信息,对发生肺出血有一定的预测作用。Objective To investigate the risk factors for pulmonary hemorrhage in very low birth weight infant(VLBWI)and to establish a prediction model.Methods A retrospective analysis was conducted on the clinical data of 142 VLBWI cases admitted to the First Affiliated Hospital of Anhui Medical University from October 2016 to October 2023,and they were divided into the pulmonary hemorrhage group(63 cases)and the non-pulmonary hemorrhage group(79 cases)according to the diagnostic criteria of neonatal pulmonary hemorrhage.Clinical characteristics,and coagulation and blood gas analysis indexes were collected,and a univariate analysis was performed before incorporating multifactorial logistic regression to analyze the high risk factors,constructing a prediction model,and evaluating the VLBWI pulmonary hemorrhage prediction model through the receiver operator characteristic(ROC),calibration,and decision curves.Results Comparison showed no statistically significant differences in gender,cesarean section,abnormal amniotic fluid volume,contaminated amniotic fluid,placental abnormality,umbilical cord abnormality,artificial insemination,and tracheal intubation between pulmonary hemorrhage group and the non-pulmonary hemorrhage group(P>0.05).There were statistically significant differences in birth weight,gestational age,use of pulmonary surfactant(PS),premature rupture of membranes>18 hours,use of prenatal glucocorticoids,hypoalbuminemia,1 minute Apgar score,5 minutes Apgar score,prothrombin time,prothrombin activity,international normalized ratio,activated partial thromboplastin time(APTT),fibrinogen,partial pressure of carbon dioxide,HCO^(3-),total carbon dioxide,and ionized calcium(iCa)between the two groups(P<0.05).Multifactorial logistic analysis showed that use of prenatal glucocorticoids and iCa were protective factors for the development of pulmonary hemorrhage in VLBWI,and use of PS and APTT were independent risk factors for the development of pulmonary hemorrhage in VLBWI(P<0.05).The above four independent factors were in

关 键 词：肺出血 极低出生体重儿 糖皮质激素 肺表面活性物质 活化部分凝血活酶时间 游离钙 

分 类 号：R722.1[医药卫生—儿科]