早产儿机械通气治疗后支气管肺发育不良危险因素分析

Analysis of risk factors of bronchopulmonary dysplasia(BPD) in premature infants with mechanical ventilation

目的探讨早产儿支气管肺发育不良(BPD)的危险因素及预防对策。方法回顾性分析本院2000年1月至2005年8月应用呼吸机治疗并住院28 d以上的早产儿,比较并综合分析20余种高危因素与BPD发生的关系。结果106例呼吸机治疗、住院>28 d早产儿BPD发生率为30.19%(32/106),占所有住院28 d以上早产儿的13.91%(32/230),占住院28 d以上、应用机械通气治疗、出生体重≤1 500 g早产儿的18.52%(25/135)。BPD组FiO2、PIP、PEEP、MAP、上机时日龄与对照组无显著性差异(P>0.05)。多因素Logistic回归分析显示:出生体重≤1 250 g、机械通气≥10 d、痰培养阳性2次以上为发生BPD的独立危险因素。结论避免低出生体重早产儿、缩短应用机械通气时间、防止及减少肺部感染,尤其是严重感染是预防早产儿发生BPD的重要措施。

Objective To investigate the risk factors for prevention and treatment of bronchopulmonary dysplasia in premature infants. Methods A retrospective study was performed in premature infants with mechanical ventilation and hospitalized more than 28 days. More than twenty factors were analysed as the risk factors of BPD. Results The overall incidence of BPD in infants with mechanical ventilation and hospitalized more than 28 days was 30.19% （32/106）, and 13.91% （32/230） in those infants who hospitalized more than 28 days, and 18.52 % （25/135） in those infants with hospitalization 〉 28 days, mechanical wentilation, and birth weight ≤1 500 g. FiO2, PIP, PEEP, MAP, and the days of starting mechanical ventilation were all not significantly different between BPD group and control group （P 〉 0.05） ;Multivariate logistic analysis revealed that birth weight less than 1 250 g, prolonged mechanical ventilation（≥ 10 days）, and positive culture of lower respiratory secretion more than twice were independent risk factors of BPD. Conclusion Prevention of premature labor of very low birth weight infants, short the duration of mechanical ventilation and prevent pneumonia, particularly serious pnenumonia were important in preventing BPD.