新生儿呼吸窘迫综合征合并支气管肺发育不良危险因素分析

Risk factors for bronchopulmonary dysplasia in neonates with respiratory distress syndrome

目的探讨新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)合并支气管肺发育不良(bronchopulmonary dysplasia,BPD)的危险因素。方法回顾性分析2011年1月至2016年12月首都儿科研究所附属儿童医院NICU病房收治的住院时间大于28 d的69例NRDS患儿临床资料,根据是否并发BPD分为BPD组和非BPD组,分析两组患儿出生时情况、母亲孕期状况、治疗情况及并发症等。结果 69例NRDS患儿中29例发生BPD,发生率为42%(29/69),未发生BPD的对照组患儿40例。胎龄、出生体重、男婴、剖宫产、Apgar 1 min≤7分、应用肺表面活性物质(pulmonary surfactant,PS)、机械通气时间、持续气道正压通气时间(continuous positive airway pressure,CPAP)、氧疗持续时间、吸入氧浓度≥40%、动脉导管未闭(patent ductus arteriosus,PDA)、呼吸机相关性肺炎、痰培养阳性例数在2组间比较差异均有统计学意义(P<0.05)。多元logistic回归显示胎龄、出生体重、动脉导管未闭是发生BPD的独立危险因素(P<0.05)。结论避免低体重早产儿,缩短机械通气时间、减少动脉导管开放,是预防NRDS发生BPD的重要措施。

Objective To identify the risk factors for bronchopulmonary dysplasia（BPD） in neonates with respiratory distress syndrome（NRDS）. Methods The retrospective study included 69 children who were admitted to the Capital Institute of Pediatrics from January 2011 to December 2016 and survived over 28 days. According to the occurrence of BPD, the subjects were divided into BPD group and non-BPD group. Factors such as neonatal basic information, maternal information, treatments and complications were compared between the two groups. Results In the 69 neonates, 29 developed BPD, the incidence rate was 42%. 40 had no BPD. There were significant differences between the two groups in gestational age, birth weight, gender, caesarean section, 1 min Apgar score7, pulmonary surfactant, the duration of mechanical ventilation, the duration of continuous positive airway pressure, the duration of oxygen, the inhaled oxygen concentration≥40%, patent ductus arteriosus（PDA） and ventilator-associated pneumonia. Multivariate logistic regression revealed that gestational age, birth weight, PDA were independent risk factors of BPD（P〈0.05）. Conclusion Preventing the preterm delivery, shortening the duration of oxygen and reducing PDA are key factors to reduce BPD in neonates with RDS.