早产儿支气管肺发育不良的高危因素及防治对策

Risk factors and prevention countermeasures in preterm infants with bronchopulmonary dysplasia

目的 研究早产儿支气管肺发育不良的高危因素及防治对策。方法 统计2010年1月-2013年12月在我院妇产科出生的早产儿498例的胎龄,出生体重,机械通气参数,是否发生宫内感染,产前或产后是否使用肺泡表面活性物质、肾上腺皮质激素等药物,是否输血,是否发生败血症、动脉导管未关闭以及肺透明膜病等合并症,分析上述指标与早产儿支气管肺发育不良之间的关系。结果 早产儿支气管肺发育不良发生率为7.23%。低胎龄、低出生体重、宫内感染、吸入氧气浓度〉40%、机械通气吸气峰压〉20cm H2O、机械通气潮气量〉6ml/kg、应用呼吸机〉3d、胎龄≤32周且未用使用肾上腺皮质激素及肺泡表面活性物质、输血、未早期喂养、合并症、胎膜早破等为早产儿支气管肺发育不良的高危因素。结论 预防感染与早产,使用肾上腺皮质激素及肺泡表面活性物质,早期喂养,于低吸气峰压、低潮气量以及低浓度氧气的前提下机械通气,尽量降低输血量及液体入量,降低并发症发生率等是防治早产儿支气管肺发育不良的对策。

Objective To analyze the risk factors and prevention countermeasures in preterm infants with bronchopulmonary dysplasia. Methods The related paraments of 498 premature infants were statistically collected, including gestational age, birth weight, mechanical ventilation, intrauterine infection, using pulmonary surfactant prenatally or postnatally, adrenal cortical hormone drugs, blood transfusion, sepsis, closure of artery catheter and hyaline membrane disease and other comorbidities. The relationship between the indexes and preterm infants with branchopulmonary dysplasia was analyzed. Results The incidence of preterm infants with bronchopulmonary dysplasia was 7.23%. The high risk factors included low gestational age, low birth weight, intrauterine infection, the inhalation of oxygen concentration 〉 40%, the peak inspiratory pressure of mechanical ventilation 〉 20 cmH2O, mechanical ventilation tidal volume 〉 6ml/kg, application of ventilator 〉 3D, gestational age ≤32 weeks and not use the adrenal cortex hormone and pulmonary surfactant, blood transfusion, delayed feeding, complications, and premature rupture of membranes break. Conclusion The countermeasures to prevent preterm infants with bronchopulmonary dysplasia include the prevention of infection and premature delivery, adrenal cortical hormone and pulmonary surfactant, the use of early enteral feeding, mechanical ventilation under the low peak inspiratory pressure, low volume and low concentration of oxygen, and reducing the amount of blood transfusion and liquid intake.