极低出生体质量儿动脉导管未闭及动脉导管再次开放的高危因素分析

Risk factors of patent ductus arteriosus and arterial ductus patency again in very low birth weight infants

目的探讨极低出生体质量早产儿动脉导管未闭(PDA)发生及引起早产儿动脉导管再次开放的危险因素。方法选择2013年1月至2015年12月河南省人民医院收治的出生体质量<1 500 g的早产儿913例作为研究对象。分别于出生后3、7 d行床旁超声心动图检查,了解PDA的发生率、动脉导管自发关闭率及再次开放率。根据出生后3 d床边超声心动图检查结果将早产儿分为PDA组(n=467)和非PDA组(n=446);根据出生后7 d床旁超声心动图检查结果将早产儿分为动脉导管关闭组(n=408)和动脉导管未关闭组(n=505),将非PDA组早产儿再分为动脉导管关闭组(n=364)和动脉导管再次开放组(n=82);采用单因素和多因素logistic回归分析探讨引起PDA和动脉导管再次开放的危险因素。结果出生后3 d PDA组和非PDA组早产儿的性别、分娩方式、羊水减少、胎膜早破、胎盘早剥、母孕期糖尿病、子痫、母孕期妊娠高血压综合征、贫血等情况比较差异均无统计学意义(P>0.05),而胎龄、出生体质量、出生窒息病史、呼吸窘迫综合征、宫内窘迫、感染、代谢性酸中毒、呼吸支持、氧疗时间比较差异有统计学意义(P<0.05)。早产儿出生后7 d动脉导管关闭组和动脉导管未关闭组胎龄、出生体质量、出生窒息病史、呼吸窘迫综合征、宫内窘迫、感染、呼吸支持、氧疗时间比较差异均有统计学意义(P<0.05);2组早产儿的性别、分娩方式、羊水减少、胎膜早破、胎盘早剥、母孕期糖尿病、子痫、母孕期妊娠高血压综合征、代谢性酸中毒、贫血等比较差异无统计学意义(P>0.05)。446例非PDA早产儿出生后7 d动脉导管再次开放组和动脉导管关闭组在胎龄、出生体质量、胎膜早破、宫内窘迫、出生窒息病史、呼吸窘迫综合征、感染、呼吸支持、氧疗时间等方面比较差异有统计学意义(P<0.05);2组早产儿在性别、分娩方式、羊水减少、胎盘早剥、母孕期糖尿病、子痫、母孕期妊娠高血压综合征、代谢性酸中毒和贫血等方面比较差异无统计学意义(P>0.05)。Logistic回归分析结果显示,呼吸窘迫综合征、感染是PDA发生的独立危险因素(P<0.05),胎龄和出生体质量为独立保护性因素(P<0.05)。结论关注早产儿PDA发生的高危因素,早期预防PDA或动脉导管再次开放,可提高早产儿的存活率和生存质量。

Objective To explore the risk factors of patent ductus arteriosus（ PDA） and aterial ductus patency again in very low birth weight premature infants. Methods Nine hundred and thirteen premature neonate with very low birth weight in Henan Provincial People＇s Hospital from January 2013 to December 2015 were selected as study subject. Bedside ultrasoundcardiogram examination was performed at 3,7 d after birth to understand the incidence of PDA,spontaneous closure rate of ductus arteriosus and the rate of aterial ductus patency again of premature infants. The premature infants were divided into PDA group（ n = 467） and non PDA group（ n = 446） according to the result of bedside ultrasoundcardiogram examination at 3 d after birth; the premature infants were divided into ductus arteriosus closure group（ n = 408） and non ductus arteriosus closure group（ n = 505）,and the premature infants in non PDA group were divided into ductus arteriosus closure group（ n = 364） and ductus arteriosus opening group（ n = 82） according to the result of bedside ultrasoundcardiogram examination at 7 d after birth. The risk factors of PDA and aterial ductus patency again were analysed by single factor analysis and logistic regression analysis. Results There was no statistic difference in sex,birth mode,oligohydramnios,premature rupture of membranes,placental abruption,diabetes mellitus in pregnancy,eclampsia,hypertension syndrome of pregnancy and anemia of premature infants beteen the PDA group and non PDA group at 3 d after birth（ P〈0. 05）; there was statistic difference in gestational age,birth weight,birth asphyxia history,neonatal respiratory distress syndrome（ NRDS）,fetal distress,infection,metabolic acidosis,respiratory support,oxygen therapy time premature infants between the PDA group and non PDA group at 3 d after birth（ P〉0. 05）. There was statistic difference in gestational age,birth weight,birth asphyxia history,NRDS,fetal distress,infection,respiratory support,oxygen therapy time of premature infants between ductus arteriosus closure group and ductus arteriosus opening group at7 d after birth（ P〈0. 05）; there was no statistic difference in sex,birth mode,oligohydramnios,premature rupture of membranes,placental abruption,diabetes mellitus in pregnancy,eclampsia,hypertension syndrome of pregnancy,metabolic acidosis and anemia of premature infants between the two groups at 7 d after birth（ P〉0. 05）. In 446 non PDA patients,there was statistic difference in gestational age,birth weight,premature rupture of membranes,fetal distress,birth asphyxia history,NRDS,infection,respiratory support,oxygen therapy time between ductus arteriosus closure group and ductus arteriosus opening group at 7 d after birth（ P〈0. 05）; there was no statistic difference in sex,birth mode,oligohydramnios,placental abruption,diabetes mellitus in pregnancy,eclampsia,hypertension syndrome of pregnancy,metabolic acidosis and anemia between the two groups at 7 d after birth（ P〉0. 05）. Logistic regression analysis showed that NRDS and infection were the independent risk factors of PDA,gestational age and birth weight were the protective factors of PDA（ P〈0. 05）. Conclusion Pay attention to the risk factors of PDA in premature infants,and early prevention and treatment of PDA or aterial ductus patency again can improve the survival rate and quality of survival of premature infants.