早产儿支气管肺发育不良的相关危险因素分析

Risk factors of bronchopulmonary dysplasia in preterm infants

目的探讨胎龄≤32周的极低出生体重儿支气管肺发育不良（bronchopulmonary dysplasia，BPD）的相关危险因素及可能的防治方向。方法总结我院2012年10月至2014年10月收治的70例BPD患儿，选择70例胎龄≤32周且不需要依赖氧疗的极低出生体重儿作为对照组，分析两组患儿围生期可能的危险因素、氧疗和咖啡因使用情况。结果男婴较女婴更易发生BPD（P=0．000）；BPD组胎龄（P=0．000）及出生体重（P=0．002）均较非BPD组低；哮喘家族史、胎儿窘迫、羊水浑浊、官内感染、肺出血、呼吸窘迫综合征、肺表面活性物质使用、动脉导管开放、呼吸机使用时间、经鼻持续气道正压通气／经鼻间歇正压通气使用时间、氧疗持续时间、咖啡因使用差异均有统计学意义（P〈0．05）；多因素Logistic回归分析显示性别（OR=42．393，P=0．002）、胎龄≤28周（OR=58．665，P=0．002）、体重〈1250g（OR=36．453，P=0．012）、呼吸机使用时间（OR=703．696，P=0．000）是BPD发生的独立危险因素，咖啡因的使用（OR=0．025，P=0．010）和经鼻持续气道正压通气／经鼻间歇正压通气的使用（OR=0．004，P=0．002）是BPD发生的保护性因素。结论加强产前保健，尽可能减少宫内感染及早产，严格液体管理减少动脉导管开放，合理应用呼吸机，尽量选择无创机械通气，合理使用咖啡因有助于减少BPD的发生。

Objective To approach the risk factors ofbronchopulmonary dysplasia（BPD）with very low birth weight infants whose gestational age less than 32 weeks, thus it could provide a basis direction for prevention. Methods To summarize 70 neonates with BPD in October 2012 to October 2014 in our hospital, and randomly select 70 very low birth weight infants didn＇t have oxygen requirement of gestation age less than 32 weeks as control group. The perinatal risk factors,oxygen therapy and use caffeine were analyzed by using the statistical analysis of Chi-square test and logistic regression, so the risk factors and prevention direction of BPD could be provided. Results Male gender were more prone to BPD（ P = 0. 000）. Gestational age （ P = 0. 000 ） and birth weight （ P = 0. 002 ） were statistical lower in infants with BPD compared with no B PD. Family history of asthma,fetal distress ,amniotic fluid turbidity,pulmonary hemorrhage ,respiratory distress syndrome, use of pulmonary surfactant, patent ductus arteriosus ,intrauterine infection, ventilator time, nasal continuous positive airway pressure/nasal intermittent positive pressure ventilation time, duration of oxygen therapy and use of caffeine were statistical significances （P 〈 0. 05, respectively ）. Logistic regression analysis demonstrated that gender（ OR = 3. 574,P =0. （D3）, gestationai age≤28 weeks（ OR = 58. 665 ,P =0. 002 ）, birth weight 〈 1 250 g （ OR = 36. 453 ,P = 0. 012 ） and ventilator time （ OR = 703. 696,P = 0. 0（30 ） were independent risk factors for BPD infants. Using of caffeine（ OR =0. 025 ,P =0. 010） and nasal continuous positive airway pressure/ nasal intermittent positive pressure ventilation（ OR =0. 004,P =0. 002） were protective factors for BPD infants. Conclusion The incidence of BPD could be reduced by strengthening prenatal care,minimizm＇ g intrauterine infection and preterm delivery,reducing the patent ductus arteriosus by strict fluid management,using mechanical ventilation rationally,choosing a non-invasive mechanical ventilation and caffeine.