超早产儿发生支气管肺发育不良的影响因素

Risk factors for bronchopulmonary dysplasia in extremely preterm infants

目的探讨超早产儿发生支气管肺发育不良（bronchopulmonary dysplasia，BPD）的影响因素，为早期预防提供临床依据。方法回顾性收集2014年1月1日至2016年12月31日深圳市妇幼保健院新生儿重症监护病房收治的胎龄〈28周且存活≥28 d的115例超早产儿的临床资料，按是否诊断BPD分为BPD组（104例）和非BPD组（11例）。采用独立样本t检验、χ2检验和Logistic回归模型分析。结果纳入研究的超早产儿BPD发生率为90.4%（104/115），除纠正胎龄36周前转院、放弃或死亡的9例外，轻、中、重度BPD构成比分别为73.7%（70/95）、25.3%（24/95）、1.1%（1/95）。单因素分析显示BPD组与非BPD组胎龄[（26.6±1.0）与（27.6±0.2）周，t=3.553]、出生体重 [（918.7±169.1）与（1 105.0±121.1） g，t=9.012]、住院时间 [（85.2±32.4）与（56.1±9.0） d，t=6.974]、1 min Apgar评分〈8分 [62.5% （65/104）与2/11，χ2=6.528]、产房内复苏方式（χ2=21.049）、肺表面活性物质应用 [88.5% （92/104）与5/11，χ2=10.869]、有创机械通气比例[80.8% （84/104）与2/11，χ2=13.294]、有创机械通气次数 [1.0（1.2~2.0）与0.0（0.0~0.0）次，Z=3.960]、首次有创机械通气时间[12.0（2.0~24.0）与0.0（0.0~0.0） h，Z=3.997]、总有创机械通气时间[18.0（2.3~163.5）与0.0（0.0~0.0） h，Z=4.405]、总用氧时间[51.5（40.0~70.8）与13.0（7.0~25.0） h，Z=5.113]及生后24 h内应用血管活性药物的比例[52.9%（55/104）与2/11，χ2=4.792]，差异均有统计学意义（P值均〈0.01或0.05）。多因素回归分析结果显示，用氧时间（OR=1.276，95%CI：1.107~1.472）增加是BPD发生的危险因素，出生体重大（OR=0.993，95%CI：0.986~0.999）和减少使用有创机械通气（OR=0.079，95%CI：0.013~0.471）是BPD发生的保护因素。结论超早产儿BPD的发生率高，与多因素有关，减少有创机械通气和用氧时间将有助于降低BPD的发生。

ObjectiveTo investigate the risk factors for bronchopulmonary dysplasia （BPD） in extremely preterm infants and to provide clinical evidence for early prevention.MethodsClinical data of extremely preterm infants born at less than 28 gestational weeks, who were treated in the Neonatal Intensive Care Unit of Shenzhen Maternity ＆ Child Healthcare Hospital between January 1, 2014 and December 31, 2016 and survived over 28 days were studied retrospectively. These infants were divided into BPD （n=104） or non-BPD group （n=11） according to their final diagnosis. Two independent samples t-test or Chi-square test was used for statistical analysis. Risk factors for BPD were analyzed by univariate analysis and multivariate logistic regression.ResultsA total of 115 extremely preterm infants were enrolled in this study and 90.4% （104/115） of them were diagnosed with BPD. Mild, moderate and severe cases of BPD accounted for 73.7% （70/95）, 25.3% （24/95） and 1.1% （1/95） of all BPD cases respectively, except for nine cases who was referred to other hospitals, ceased for treatment or died before corrected age of 36 weeks. The univariate analysis showed that the BPD and non-BPD groups had significant differences in the following aspects： gestational age [（26.6±1.0） vs （27.6±0.2） weeks, t=3.553], birth weight [（918.7±169.1） vs （1 105.0±121.1） g, t=9.012], length of hospital stay [（85.2±32.4） vs （56.1±9.0） d, t=6.974], 1 min Apgar score〈8 [62.5% （65/104） vs 2/11, χ2=6.528], methods of neonatal resuscitation in deliver room （χ2=21.049）, administration of pulmonary surfactant [88.5% （92/104） vs 5/11, χ2=10.869], invasive ventilation [80.8% （84/104） vs 2/11, χ2=13.294], times of invasive ventilation [1.0 （1.2-2.0） vs 0.0 （0.0-0.0） times, Z=3.960], duration of the first invasive ventilation [12.0 （2.0-24.0） vs 0.0 （0.0-0.0） h. Z=3.997], total length of all invasive ventilations [18.0 （2.3-163.5） vs 0.0 （0.0-0.0） h, Z=4.405], duration of oxygen therapy [51.5 （40.0-70.8） vs 13.0 （7.0-25.0） h, Z=5.113] and administration of vasoactive agents during the first 24 hours after birth [52.9% （55/104） vs 2/11, χ2=4.792], which indicated that they were risk factors for BPD in extremely preterm infants. Results of the multivariate logistic regression analysis showed that prolonged length of oxygen therapy [OR=1.276 （95%CI： 1.107-1.472）, P=0.001] was the risk factor, while high birth weight [OR=0.993 （95%CI： 0.986-0.999）, P=0.037] and reduced usage of invasive ventilation [OR=0.079 （95%CI： 0.013-0.471）, P=0.005] were protective factors against BPD.ConclusionsThe incidence of BPD which can be influenced by many factors is really high in extremely preterm infants. Avoiding invasive ventilation, shortening the duration of oxygen therapy and adopting a comprehensive and standardized treatment at an early stage may decrease the incidence of BPD.