早产儿肺出血危险因素的研究

The risk factors of the pulmonary hemorrhage in premature infants

目的探讨早产儿肺出血可能的危险因素。方法从本院儿科1994—2005年所有住院早产儿病案中选取肺出血病例作为病例组,根据病例组例数,按照1∶2的比例选取对照组进行病例对照研究,采用Logistic回归对早产儿肺出血危险因素进行多因素分析。结果病例组40例,对照组80例。单因素分析显示,早产儿肺出血的危险因素包括:母亲妊娠期糖尿病,早产儿胎龄、出生体重、非第1产、生后窒息时间、生后1minApgar评分≤7、生后5minApgar评分≤7,并发呼吸窘迫综合征、新生儿肺炎、呼吸暂停、颅内出血、动脉导管未闭、低钠血症、高糖血症、血小板减少、心力衰竭、pH值<7.2、低血压、应用肺表面活性物质和呼吸机,共20项因素与肺出血的关联有统计学意义;Logistic回归多因素分析显示,非第1产(OR=13.861)、生后1minApgar评分≤7(OR=14.112)、并发呼吸暂停(OR=20.444)和应用呼吸机(OR=44.869)与肺出血的关联有统计学意义。结论非第1产、生后1minApgar评分≤7、并发呼吸暂停和应用呼吸机是早产儿肺出血的危险因素。对有肺出血危险因素的早产儿应密切监测,以早诊断、早治疗,从而降低早产儿肺出血的发病率和病死率。

Objective To investigate the possible risk factors of the pulmonary hemorrhage in the prematures. Methods A hospital-based case-control study including 40 prematures with pulmonary hemorrhage hospitalization from 1994 to 2005 in our hospital and 80 prematures controls in the corresponding time period was carried out to analyse the muhivariable risk factors of the pulmonary hemorrhage. Results In all the cases （1378）, the prematures with pulmonary hemorrhage were 40 and the controls were 80. Univariate analysis demonstrated that mother suffered from the diabetes in gestation period, gestational age of the premature, the birth weight of the premature, non first birth, with the asphyxiation time after birth, the Apgar scores in one minute lower or equal to 7, the Apgar scores in five minutes lower or equal to 7, the respiratory distress syndrome, pneumonia, apnea, intracranial hemorrhage, patent ductus arteriosus, hyponatremia, hyperglycemia, thrombocytopenia, heart failure, pH values lower than 7.2, hypotension, using the pulmonary surfactant and the mechanical ventilator therapy. There were 20 factors in totals which had statistical significance to the pulmonary hemorrhage of the prematures. Muhivariable analysis of the logistic regression demonstrated that not the first birth （OR = 13. 861,95% CI： 1. 807 - 106. 301 ） , the Apgar scores in one minute lower or equal to 7 （ OR = 14. 112, 95% CI： 2. 368 - 83. 483 ）, with the apnea （ OR = 20. 444,95% CI： 2. 912 - 143.513 ） and using the mechanical ventilator therapy（ OR =44. 869,95% CI：6. 499 -309. 792）were the 4 factors in totals whichhad statistical significance to the pulmonary hemorrhage of the prematures. Conclusion In this study, non first birth, the Apgar scores in one minute lower or equal to 7, apnea and the mechanical ventilator therapy were the risk factors of the pulmonary hemorrhage of the prematures. We should monitor those prematures who had the risk factors more closely, so we could diagnose and treat them more earlier and decrease the morbidity and the mortality rate of the pulmonary hemorrhage in the prematures.