早产儿支气管肺发育不良危险因素分析

An analysis of risk factors of premature infants with bronchopulmonary dysplasia

目的 探讨早产儿支气管肺发育不良的危险因素,深入了解其发病机制,为支气管肺发育不良的防治提供理论参考.方法 回顾性分析2008年在北京军区总医院附属八一儿童医院早产儿病房住院,且胎龄在34周以内,并生存28天以上的311例早产儿资料.以支气管肺发育不良的发生与否分为支气管肺发育不良组与非支气管肺发育不良组,并对多种高危因素与支气管肺发育不良的发生关系进行统计学分析.结果 早产儿支气管肺发育不良发生率为11.3%（35/311）.支气管肺发育不良组与非支气管肺发育不良组比较,患儿的出生胎龄、体重及并发动脉导管未闭、肺出血、气胸、痰培养阳性、呼吸机相关性肺炎、肺透明膜病、呼吸机治疗、败血症、肺动脉高压、出生时窒息、其母为妊娠期高血压疾病均有显著性差异（均P〈0.05）,而性别、低血糖、产前应用激素、胎膜早破（〉18小时）等因素则无显著性差异（均P〉0.05）.经Logistic回归分析显示,患儿的出生体重、呼吸机治疗、呼吸机相关性肺炎、败血症为支气管肺发育不良的独立危险因素.结论 应尽可能地避免低出生体重早产儿出生,减少感染,合理应用机械通气以减少肺部并发症是预防早产儿发生支气管肺发育不良的重要措施.

Objective To investigate risk factors of bronchopulmonary dysplasia （BPD） of premature infant and to explore mechanisms of BPD so as to provide a basis for prevention and treatment of the disease. Methods The clinical data of 311 premature infants with gestational age less than 34 weeks and survival time over 28 days in our hospital in 2008 were retrospectively analyzed. The premature infants were divided into two groups ： BPD group and non-BPD group, and the risk factors and their relationships with BPD were statistically analyzed by using SPSS 16.0 software. Results The incidence of BPD among premature infants was 11.3% （35/311 ）. In gestational age, birth weight of the premature infants and incidences of premature infants＇ complications of patent ductus arteriosus （ PDA ） , pulmonary hemorrhage, pneumothorax, positive sputum culture result, ventilator-associated pneumonia, hyaline membrane disease, mechanical ventilation treatment, septicemia, pulmonary hypertension, birth asphyxia and their mother suffering from hypertensive disorder complicating pregnancy, there were significant differences between the non-BPD group and BPD group （ all P 〈 0.05 ）. However, in sex, glycopenia, use of glucocorticoids before delivery and premature rupture of memberane（ 〉 18 hours） , there were no significant differences between the two groups （ all P 〉 0.05 ）. Logistic regression analysis showed that birth weight, mechanical ventilation treatment, ventilator-associated pneumonia, septicemia were independent risk factors for BPD. Conclusion Avoiding birth of low birth weight infants, reducing incidence of infection, rational use of mechanical ventilation to reduce pulmonary complications, were important measures to prevent occurrence of BPD of the premature infants.