早产儿动脉导管未闭高危因素及并发症分析

Patent ductus arteriosus in preterm infants: a study of the high risk factors and complications

目的探讨早产儿动脉导管未闭(PDA)发生的危险因素及相关并发症。方法采用回顾性分析的方法,对2012年4月至2013年4月我院新生儿重症监护病房收治的PDA早产儿(观察组)和无PDA的早产儿(对照组)临床资料进行病例对照研究,在早产儿PDA暴露因素的单因素分析基础上,进行Logistic回归模型,分析早产儿PDA的危险因素及并发症。结果观察组96例,对照组170例,两组患儿一般资料差异无统计学意义(P>0.05)。单因素分析显示母亲妊娠期高血压、产前应用硫酸镁、宫内窘迫、胎盘病变、脐带异常、羊水减少、窒息、败血症、新生儿呼吸窘迫综合征、代谢性酸中毒、应用肺表面活性物质、呼吸支持及生后第1、2天液体入量与早产儿PDA相关联。并发症中脑室内出血、早产儿视网膜病、支气管肺发育不良与早产儿PDA相关联。多因素回归分析显示,呼吸支持(OR=0.868)、母亲产前应用硫酸镁(OR=0.247)是早产儿发生PDA的保护因素,败血症(OR=2.519)是早产儿发生PDA的独立危险因素。结论早期识别早产儿PDA的危险因素,积极预防和治疗PDA引起的并发症,对提高新生儿存活率及降低后遗症发生率有一定临床意义。

Objective To study the high risk factors and complications of patent ductus arteriosus（ PDA） in preterm infants. Methods A case-control study was conducted on preterm infants hospitalized in our NICU between April 2012 and April 2013 by retrospectively. The clinical data of premature infants with and without PDA were studied. The risk factors and complications were identified.Data were analyzed using single factor analysis and Logistic regression. Results Comparisons were made between 96 infants with PDA（ observation group） and 170 infants without PDA（ control group）. There was no statistical significant difference for the general information of patients between observation group and control group（ P〉 0. 05）. Single factor analysis showed that PDA in preterm infants was significantly associated with pregnancy-induced hypertension,antenatal magnesium sulfate use,intrauterine distress,placental lesions,umbilical cord abnormality,decreased amniotic fluid,asphyxia,sepsis,respiratory distress syndrome（ RDS）, metabolic acidosis, Exogenous pulmonary surfactant（ PS） replacement therapy,respiratory ventilatory or mechanical ventilation support,the first day and second day fluid intake. The incidence of complications including intraventricular hemorrhage（ IVH）,bronchopulmonary dysplasia（ BPD） and retinopathy of prematurity（ ROP） in the observation group were higher than that in the control group. The Logistic regression analysis showed that respiratory support（ OR = 0. 868） and the use of magnesium sulfate（ OR = 0. 247） were protective factors for PDA in preterm infants,and sepsis（ OR = 2. 519） was the major risk factor. Conclusions Early identification of risk factors for PDA in premature infants, active prevention and treatment of complications of PDA have some clinical significance for improving the survival rate and reducing the incidence of sequelae in preterm infants.