早产儿HsPDA危险因素及其并发症的临床分析

Clinical analysis of risk factors for and complications of patent ductus arteriosus and hemodynamically significant patent ductus arteriosus in premature infants

目的探讨早产儿动脉导管未闭(PDA),尤其是有血流动力学改变的PDA(HsPDA)发生的危险因素及其相关并发症。方法选择2017年1月-2018年1月中国科学技术大学附属第一医院NICU收治的149例早产儿,根据PDA和HsPDA诊断标准将符合条件的早产儿分为HsPDA组、nHsPDA组和nPDA,将其临床资料进行回顾性病例对照分析,进行单因素分析后进行logistic回归分析,并对早产儿PDA的并发症与其关闭时间进行相关性分析。结果 HsPDA组23例、nHsPDA组11例和nPDA组115例,3组患儿的一般资料比较差异无统计学意义(P>0.05),单因素分析结果示:3组患儿胎龄、出生体重、多胎和Apgar评分比较差异有统计学意义。Logistic回归分析结果示多胎(P=0.009)、Apgar评分≤3分(P=0.010)和Apgar评分3~7分(P=0.036)是PDA/HsPDA发病的独立风险因素。与并发症之间的相关性结果示IVH与HsPDA的相关性(R2=0.884)、ROP与nHsPDA的相关性(R3=0.841)最为显著。关闭时间与并发症之间相关风险结果示BPD(R1=1.308,R2=1.174)、ROP(R1=1.308,R2=1.161)均有不同程度相关性,且均为与HsPDA的相关性高于nHsPDA。结论多胎、Apgar低评分构成了PDA/HsPDA发生的独立危险因素,HsPDA相比较nHsPDA在与IVH/BPD之间有显著的相关性,关闭时间与BPD/ROP之间具有显著相关性。

Objective To study the risk factors for patent ductus arteriosus(PDA), especially hemodynamically significant patent ductus arteriosus(HsPDA) and the related complications. Methods A case-control study was conducted retrospectively on the clinical data of 149 preterm infants hospitalized in our NICU between January 2017 and January 2018. The patients were assigned into HsPDA, nHsPDA and nPDA according to the diagnostic criteria for PDA and HsPDA. The single factor analysis was conducted among observed variables, and then logistic regression was performed to conclude the independent risk factors for PDA/HsPDA. We also analyze the related risk factors of complications with PDA/HsPDA and ductal closure time. Results There were 23 patients in the HsPDA group, 11 patients in the nHsPDA group and 115 patients in the nPDA group, and no statistical significant difference for the general information was found among the three groups(P>0.05). Single factor analysis showed that PDA/HsPDA was significantly associated with gestational age, multiple pregnancy, Apgar scores and birth weight, the difference among the three groups was significantly(P>0.05);the logistic regression analysis showed that multiple pregnancy(P=0.009), and Apgar scores(for ≤3 scores, P=0.010;for 3 to 7 scores, P=0.036) were the independent risk factor for PDA/HsPDA. Among the three kinds of complications, the relationship between intraventricular hemorrhage(IVH) and HsPDA(R2=0.884), the relationship between retinopathy of prematurity(ROP) and nHsPDA(R3=0.841) were the most significant, the correlations for IVH was more obvious in the HsPDA group when compared with the nHsPDA group, for ROP was contrary to it. The bronchopulmonary dysplasia(BPD, R1=1.308, R2=1.174) and ROP(R1=1.308, R2=1.161) showed more significant relationship to the time of ductal closure, especially in the HsPDA. Conclusion Multiplets and lower Apgar scores are the independent risk factors for PDA/HsPDA. IVH and BPD show more significant relationship with HsPDA when compared with nHsPDA. The ductal closure time correlates closely with BPD and ROP.