极低出生体重儿肺出血预后的影响因素分析

Analysis of characteristics of pulmonary hemorrhage prognosis in very low birth weight

目的探讨极低出生体重儿肺出血死亡的原因,对影响肺出血预后的危险因素进行分析。方法选取2015年8月至2019年12月发生肺出血的极低出生体重儿41例,按照预后分为存活组(25例)和死亡组(16例);并按照胎龄分层,超早产儿12例(胎龄≤28周),早产儿29例(28周<胎龄<37周)。分析各组的一般临床情况、止凝血功能及肺出血发生后的通气模式及参数选择情况。结果早产儿组存活组出生体重大于死亡组,两组有统计学差异(P<0.05);早产儿组存活组活化部分凝血酶原活动度(APTT)低于死亡组,两组有统计学差异(P<0.05);存活组的高频振荡通气使用率高于死亡组(P<0.05);存活组呼气末正压PEEP显著高于死亡组,两组有统计学差异(P<0.01)。结论出生体重和活化部分凝血酶原活动度是影响早产儿肺出血预后的危险因素;肺出血发生后,高频振荡通气优于同步间歇指令通气;呼气末正压是影响极低出生体重儿肺出血预后的危险因素。

Objective To investigate the prognostic factors and indicators of pulmonary hemorrhage in very low birth weight children.Methods It chose 41 cases of very low birth weight neonate with pulmonary hemorrhage from August 2015 to December 2019,including 25 survival cases and 16 dead cases.The super premature was 24 weeks to 28 weeks(12 cases),and premature was greater than 28 weeks and less than 37 weeks(29 cases).Their clinical situation,anticoagulant function,ventilation mode and parameter selection after pulmonary hemorrhage were analyzed.Results The birth weight of the survival group of premature infants was higher than that in the death group(P<0.05).The activated partial prothrombin activity(APTT)of the premature survival group was lower than that in the death group(P<0.05).The usage of High Frequency Oscillatory Ventilation(HFOV)in the survival group was higher than that in the dead group(P<0.05).The positive end expiratory pressure(PEEP)was higher in the survival group than in the death group(P<0.01).Conclusion Birth weight and activity of activated partial prothrombin are the risk factors for the prognosis of premature pulmonary hemorrhage.After pulmonary hemorrhage,the choice of High Frequency Oscillatory Ventilation(HFOV)is superior than Synchronized Intermittent Mandatory Ventilation(SIMV),and positive end expiratory pressure(PEEP)is a risk factor affecting the prognosis of very low birth weight neonates.