121例支气管肺发育不良患儿2岁内再入院的临床分析

Readmission of children with bronchopulmonary dysplasia in the first 2 years of life: a clinical analysis of 121 cases

目的总结支气管肺发育不良(BPD)患儿2岁内再入院的临床情况。方法回顾性分析121例BPD患儿2岁内242例次因反复下呼吸道感染再入院的临床资料。结果 242例次再入院BPD患儿中,115例次(47.5%)有喘息;1~2岁患儿喘息发生率高于1岁内患儿(P<0.05)。193例次行胸部影像学检查,结果示囊泡影31例次(16.1%)。肺功能检查结果示BPD患儿的每公斤体重潮气量(TV/kg)、达峰时间比(TPEF/TE)、达峰容积比(VPEF/VE)、50%潮气量时的呼气流速(TEF50)、75%潮气量时的呼气流速(TEF75)均低于无呼吸道疾病的对照组,而呼吸频率高于对照组(P<0.05)。28例行支气管镜检查,气道发育异常21例(75%)。242例次均吸入糖皮质激素,无治疗相关不良反应发生;6例次静脉使用人脐血间充质干细胞(hUCB-MSCs),无不良反应发生,其中1例治疗后顺利脱氧。结论因下呼吸道感染再入院BPD患儿喘息发生率随年龄增长而增高,其肺功能以小气道阻塞、低肺容量时呼气流速降低和呼吸频率增快为主要表现,多伴有气道发育异常。吸入糖皮质激素可用于BPD再入院患儿急性期抑制炎症反应;hUCB-MSCs输注后短期安全可行,并提示可能对BPD恢复有一定益处。

Objective To investigate the clinical features of readmitted children with bronchopulmonary dysplasia（BPD） in the first 2 years of life. Methods A retrospective analysis was performed for the clinical data of 242 children with BPD who were readmitted due to recurrent lower respiratory tract infection（LRTI） in the first 2 years of life. Results Among all the 242 children with BPD, 115（47.5%） had wheezing, and the children aged 1-2 years had a significantly higher incidence rate of wheezing than those aged less than 1 year（P0.05）. Chest imaging was performed for 193 children, among whom 31（16.1%） had hyperlucent areas. Pulmonary function examination showed that the BPD children had significantly lower TV/kg, TPEF/TE, VPEF/VE, TEF50 and TEF75, and significantly higher respiratory rate than the controls without respiratory disease（P0.05）. Bronchoscopy was performed for 28 children, among whom 21（75%） had airway dysplasia. All the 242 children used inhaled corticosteroids（ICS） and experienced no treatment-related adverse reactions. Six children were given intravenous infusion of human umbilical cord blood mesenchymal stem cells（h UCBMSCs） and experienced no infusion-related events or adverse reactions, among whom one child successfully stopped oxygen therapy. Conclusions The incidence rate of wheezing increases with the increase in age in children with BPD who are readmitted due to LRTI. Pulmonary function examination shows small airway obstruction, reduced expiratory flow rate in case of low lung capacity, and increased respiratory rate, and most children have airway dysplasia. ICS can be used to inhibit inflammatory response in the acute stage. Infusion of hU CB-MSCs is safe and feasible and may bring some benefits to the recovery from BPD.