生后早期血液学参数预测早产儿有血流动力学意义动脉导管未闭的研究

Early Hematological Parameters Predicting Hemodynamic Significance of Arterial Catheterization in Premature Infants

目的探讨生后早期血液学相关参数预测早产儿有血流动力学意义动脉导管未闭的意义。方法方便收集南方医科大学附属深圳市妇幼保健院新生儿重症监护室2018年1月—2019年6月收治的诊断有血流动力学意义动脉导管未闭(hsPDA)的早产儿共124例为病例组,以胎龄和出生体重为匹配因素按1:1的比例从同期住院的早产儿中选取124名无血流动力学意义动脉导管未闭的早产儿作为对照组。收集纳入病例的临床资料及入院1周内的血常规指标。分析早产儿早期血液学参数对有血流动力学意义动脉导管未闭的预测意义。结果单因素分析显示,病例组与对照组的血小板数214.00(165.00~264.25)×10^9/L与240.00(195.00~280.50)×10^9/L、血小板压积19.65(15.78~24.1)%vs 21.80(18.23~25.48)%,差异有统计学意义(U=5900.000,5989.000,P<0.05)。多因素回归分析显示,宫内感染是hsPDA发生的独立危险因素,而产前足疗程糖皮质激素治疗和生后一周内相对较高的血小板计数是hsPDA发生的保护因素。结论生后一周血小板减低和宫内感染可能是早产儿hsPDA的独立危险因素,而产前应用足疗程的糖皮质激素是其保护因素。

Objective To explore the significance of early postnatal hematology related parameters to predict the hemodynamic significance of premature infants with patent ductus arteriosus.Methods A total of 124 premature infants diagnosed with hemodynamic significance of patent ductus arteriosus(hsPDA)in neonatal intensive care unit of Shenzhen Maternal and Child Health Hospital affiliated to Southern Medical University from January 2018 to June 2019 were collected.The case was a case group,and 124 premature infants without hemodynamic significance of arterial catheterization were selected as the control group from the premature infants hospitalized at the same time based on the matching factor of gestational age and birth weight.Collect clinical data of the included cases and blood routine indexes within 1 week of admission.Analyze the hematological parameters of early postnatal period for hemodynamic significance of premature infants.Results Single factor analysis showed that the number of platelets in the case group and the control group was 214.00(165.00~264.25)×10^9/L and 240.00(195.00~280.50)×10^9/L,and the plateletcrit was 19.65(15.78~24.1)%vs 21.80(18.23~25.48)%.The differences were statistically significant(U=5900.000,5989.000,P<0.05).Multivariate regression analysis showed that intrauterine infection is an independent risk factor for hsPDA,and prenatal foot therapy with glucocorticoid therapy and a relatively high platelet count within one week after birth are protective factors for hsPDA.Conclusion One week after birth,platelet reduction and intrauterine infection may be independent risk factors for hsPDA in premature infants,and glucocorticoids used for prenatal foot treatment are its protective factors.