极低出生体质量儿支气管肺发育不良的临床研究

Clinical study on bronchopulmonary dysplasia in very low birth weight infants

目的研究极低出生体质量儿中支气管肺发育不良(BPD)的发生率、危险因素、临床特点。方法以2011年9月至2014年12月收治的极低出生体质量儿为研究对象,根据BPD发生与否及严重程度分组,进行回顾性分析。结果极低出生体质量儿中BPD的发生率为17.5%,BPD组胎龄、出生体质量、Apgar评分均低于非BPD组,住院时间显著延长(P<0.05);母亲妊娠高血压、新生儿呼吸窘迫综合征(NRDS)、痰培养阳性、肺出血、呼吸暂停、呼吸衰竭及败血症的发生率,两组间进行比较差异有统计学意义(P<0.05);BPD组肺泡表面活性物质、氧疗及机械通气的使用率显著高于非BPD组(P<0.05)。Logistic回归分析显示胎龄(OR=0.474,P=0.004)、NRDS(OR=5.942,P=0.043)是BPD发生的独立危险因素。痰培养阳性次数与BPD严重程度正相关(r=0.423,P<0.01)。BPD组与非BPD组比较,累计用氧时间及累计机械通气时间在第1周、前2周、前3周、前4周差异均有统计学意义(P<0.05)。轻度BPD组与中重度BPD组比较,累计机械通气时间在上述时间段差异均有统计学意义(P<0.01)。结论 BPD是极低出生体质量儿的常见并发症,常发生于胎龄低于32周的早产儿;低胎龄是BPD发生的独立危险因素;肺部感染严重程度与发生BPD的严重程度相关;BPD组患儿在生后前几周即表现为氧依赖。

Objective To investigate the incidence ,risk factors and clinical features of bronchopulmonary dysplasia （BPD） a‐mong very low birth weight infants .Methods Very low birth weight infants admitted to our hospital from September 2011 to De‐cember 2014 .BPD were taken as the research subjects and grouped according whether BPD occurring and severity .The retrospec‐tive analysis was performed .Results The BPD occurrence rate in very low birth weight infants was 17 .5% .The gestational age , birth weight ,Apgar score in the BPD group were lower than those in the non‐BPD group ,and the hospitalization duration in the BPD group was significantly prolonged （P〈 0 .05） .The gestational hypertension ,neonatal respiratory distress syndrome （NRDS） , sputum culture positive ,pulmonary hemorrhage ,apnea ,respiratory failure and sepsis incidence had statistical difference between the two groups（P〈 0 .05） ;the use rates of pulmonary surfactant（PS） ,oxygen therapy and mechanical ventilation in the BPD group were significantly higher than those in the non‐BPD group（P〈 0 .05） .The Logistic regression analysis revealed that the gestational age（GA） （OR = 0 .474 ,P= 0 .004） and NRDS （OR = 5 .942 ,P= 0 .043） were the independent risk factors for BPD occurrence .The times of sputum culture positive was positively correlated with the severity of BPD（r = 0 .423 ,P〈 0 .001） .The accumulative oxygen use time and mechanical ventilation time at 1 ,2 ,3 ,4 weeks had statistically significant differences between the BPD group and non‐BPD group（P〈 0 .05） .The accumulative mechanical ventilation time at above time periods had statistically significant differences between the mild BPD group and severe BPD group（P 〈 0 .001） .Conclusion BPD is a common complication in very low birth weight infants ,usually occurs in preterm neonates with the gestational age less than 32 ;lower GA is an independent risk factor of BPD occurrence .The severity degree of pulmonary infection is correlated with BPD severity ;the infants with BPD show the oxygen dependency in the several weeks after.