早产儿支气管肺发育不良发生率及高危因素的多中心回顾调查分析

Incidence and risk factors of bronchopulmonary dysplasia in premature infants in 10 hospitals in China

目的了解国内早产儿支气管肺发育不良（BPD）的发生率，探讨影响其发病及其严重程度的因素，为早期预防BPD提供指导意见。方法回顾性收集国内10家NICU2006年1月1日至2008年12月31日收治的胎龄〈37周且存活≥28d早产儿临床资料，根据患儿出生后28d是否用氧（〉21％）分为BPD组和非BPD组。生后28d未用氧为非BPD组；生后持续用氧≥28d为BPD组。计算各个胎龄BPD发病率；从数字表中随机选取360例非BPD早产儿做为对照组进行对比研究，对两组患儿临床资料进行对比研究；并对两组患儿生后10d内的总液体量、热卡摄人以及体重下降的百分比进行了组间比较。同时根据卅生时胎龄在生后不同日龄进行评估疾病严重程度，即如胎龄〈32周，在校正胎龄36周或出院时进行评估；如胎龄≥32周，在生后56d或出院时评估：①轻度：未用氧；②中度：FiO2〈30％；③重度：FiO2≥30％或需机械通气。比较轻度BPD和中重度BPD两组患儿的临床资料。临床资料结果采用计量或计数资料描述，计量资料采取非参数检验法，计数资料采用卡方检验（fisher精确概率法）比较两组资料的差异；Logistic回归分析逐步向前引入法找出BPD发病及其病情程度的主要影响因素。结果10家医院胎龄〈37周早产儿共12351例，其中符合BPD诊断的156例，BPD发生率为1．26％。其中GA≤28、28～、30～、32～、34～、〈37周BPD发生率分别为19．3％、13．11％、5．62％、0．95％和0．09％，BPD发生率随胎龄增加明显降低。多因素逐步Logistic回归分析结果显示，体重低于1．5kg、动脉导管未闭、早产儿贫血、肺透明膜病、巨细胞病毒感染、机械通气、呼吸机持续时间≥7d及PaO2／FiO2〈300这8个因素为支气管肺发育不良患儿的高危因素。BPD组与非BPD组患儿生后5d内液体量摄入组问比较无差异，而BPD组患儿生后10d内热卡摄入以及生后前3d内体重下降的百分比明显减少（P〈0．01）。156例BPD中，20份因资料丢失过多剔除，剩余136例病例中轻度支气管肺发育不良71例，中重度65例。住院天数、用氧时间及氧浓度大于0．3持续时间、院内感染、巨细胞病毒感染、羊水污染、生后是否使用CPAP、呼吸机持续时间≥7d、生后第一次血气CO2共9个因素组间差异有统计学意义；多因素逐步Logistic回归分析结果显示，合并院内感染、巨细胞病毒感染、呼吸机持续时间≥7d这三个因素为中重度支气管肺发育不良患儿的高危因素。结论国内10家医院早产儿BPD发生率为1．26％，发病率随胎龄增加而明显降低。极低出生体重、动脉导管未闭、贫血、肺透明膜病、巨细胞病毒感染、机械通气、PaO2／FiO2〈300等是其高危因素，BPD组生后10d内热卡摄人明显低于非BPD组。预防院内感染、巨细胞病毒感染及减少机械通气持续时间可降低BPD严重程度。

Objective To determine the incidence of bronchopulmonary dysplasia （ BPD）, risk factors for development of BPD and severity of BPD among 10 neonatal intensive care units （ NICU ） in China Methods Data were retrospectively collected from 10 NICU in China between Jan. 1st 2006-Dec. 31st 2008. All babies whose gestational age was 〈 37 w and survived over 28 d were included in this study. BPD was diagnosed according to the Bancalari criteria which was oxygen dependency at 28 days of age. The incidence of BPD was calculated at different gestational age. All clinical features, maternal and neonatal risk factors, total fluid intake ad total caloric intake, percentages of weight loss from day 1 to day 10 of life were compared between non-BPD and BPD patients. BPD was classified as mild, moderate and severe according to the Bancalari criteria. All clinical features, maternal and neonatal risk factors were compared in patients with BPD. The risk factors for development of BPD and moderate/severe BPD were analyzed by logistic regression test. Results Altogether 12 351 preterm babies were included. Among them 156 cases met the criteria of BPD. The incidence of BPD was 1.26%. The incidence of BPD in gestational age （GA） ≤28 w, 28 w-, 30 w-, 32 w- and 34 w- 〈 37 w were 19. 3% , 13.11% , 5.62%, 0. 95% and 0. 09% . The incidence of BPD decreased dramatically with gestational age increase. Multivariate logistic regression model showed the risk factors for BPD were birth weight less than 1.5 kg, PDA, anemia of prematurity, RDS, CMV infection, mechanical ventilation, duration of mechanical ventilation ≥7 d and PaO2/FiO2 〈 300. Among 156 BPD cases, 20 were excluded for incomplete data, 136 were included; 71 of the 136 patients （52%） had mild BPD while 65 of 136 patients （48%） had moderate/severe BPD. Multivariate logistic regression model showed the risk factors for severity of BPD were nosocomial infection （OR：4. 587; 95% CI： 2. 104-10. 004） , CMV infection （ OR ：4. 440 ; 95% CI ： 1.519-12. 975 ） ; duration of mechanical ventilation ≥7 d （ OR ： 2. 435 ; 95 % CI ： 1.113-5. 330 ）. Conclusions The incidence of BPD was 1.26%. The incidence of BPD decreased dramatically with gestational age increase. The risk factors for BPD were birth weight less than 1.5 kg, PDA, anemia of prematurity, RDS, CMV infection, mechanical ventilation, duration of mechanical ventilation ≥7 d and PaO2/FiO2 〈 300. The most important risk factors for moderate/ severe BPD were nosocomial infection, CMV infection and duration of mechanical ventilations≥7 d.