影响超低和极低出生体重儿支气管肺发育不良严重程度的危险因素分析

Risk factors for the severity of bronchoplumonary dysplasia in extremely low birth weight infants and very low birth weight infants

目的探讨影响超低出生体重（ELBW）和极低出生体重（VLBW）婴儿支气管肺发育不良（BPD）严重程度的危险因素,为其防治提供依据。方法对2013年1月至2014年12月本院新生儿重症监护病房（NICU）收治并诊断BPD的ELBW/VLBW婴儿临床资料进行回顾性分析,按BPD严重程度分为轻、中、重度3组,比较各组间产前因素、出生时情况、住院期间并发症、治疗措施,分析ELBW/VLBW婴儿发生重度BPD的危险因素。结果研究期间共收治ELBW/VLBW婴儿438例,诊断BPD 225例,BPD发生率51.4%,其中轻度BPD 56例（24.9%）,中度BPD 74例（32.9%）,重度BPD 95例（42.2%）。BPD程度越重,出生体重〈1 000 g、气管插管时间≥7天、动脉导管未闭（PDA）、败血症/脑膜炎、输血≥3次的比例越高,组间比较差异均有统计学意义（P〈0.05）;多因素Logistic回归分析显示,气管插管时间≥7天（OR=12.064,95%CI 4.479-32.494）和输血≥3次（OR=3.553,95%CI 1.512-8.352）是ELBW/VLBW婴儿发生重度BPD的独立危险因素。结论 ELBW/VLBW婴儿发生BPD的严重程度与多因素相关,气管插管时间≥7天、输血≥3次是发生重度BPD的独立危险因素。积极预防贫血,减少气管插管时间和输血次数是减少重度BPD的重要措施。

Objective To study the risk factors for the severity of bronchopulmonary dysplasia（ BPD） in extremely low birth weight（ ELBW） infants and very low birth weight（ VLBW） infants,and to improve the prevention and treatment of BPD in ELBW and VLBW infants. Methods The data of ELBW and VLBW infants with BPD in our NICU from January 2013 to December 2014 were collected.BPD infants were classified as mild,moderate and severe groups according to the criteria. Maternal situation,basic situation,neonatal disease and treatment were compared among the three groups. Results A total of 225 cases were enrolled in our study,the incidence of BPD in ELBW and VLBW infants was51. 4%（ 225 /438）. Among these BPD infants,there were 56 cases（ 24. 9%） in mild group,74 cases（ 32. 9%） in moderate group,and 95 cases（ 42. 2%） in severe group. With the increase of the severity of BPD,the incidences of birth weight 1 000 g,intubation time ≥ 7 d,patent ductus arteriosus,sepsis / meningitis,and blood transfusion ≥ 3 times all increased,the differences were statistically significant among the three groups（ χ^2= 14. 037,P = 0. 001; χ^2= 54. 994,P〈0. 001; χ^2= 12. 449,P = 0. 002; χ^2= 33. 431,P〈0. 001; χ^2= 2. 829,P = 0. 002）. Logistic regression analysis showed that intubation time ≥7 d and blood transfusion ≥3 times were risk factors for severe BPD（ OR = 12. 064,P〈0. 001; OR = 3. 553,P = 0. 004）. Conclusions The severity of BPD in ELBW and VLBW infants is associated with multiple factors. Intubation time ≥7 d and blood transfusion ≥3 times are risk factors for severe BPD. Preventing infection and anemia,reducing time of intubation and blood transfusion times are important measures to reduce the severity of BPD.