极早产儿支气管肺发育不良相关性肺动脉高压的临床研究

Pulmonary hypertension associated with bronchopulmonary dysplasia in very premature infants

目的探讨极早产儿支气管肺发育不良(bronchopulmonary dysplasia,BPD)相关性肺动脉高压(pulmonary hypertension,PH)的临床特点及危险因素。方法选择2016年1月至2018年12月上海市儿童医院新生儿重症监护病房收治的胎龄<32周且符合BPD诊断标准的早产儿进行回顾性分析。根据生后28 d后多普勒心脏彩超检查是否存在PH分为PH组和非PH组。分析两组早产儿的基本资料、母亲妊娠期情况、多普勒心脏彩超检查结果、并发症、治疗措施、住院天数等指标。结果共纳入BPD早产儿86例,其中PH组18例,非PH组68例。PH组胎龄、出生体重低于非PH组[(28.0±1.2)周比(28.8±1.5)周,975(875,1151)g比1172(954,1374)g],重度BPD比例及母亲年龄≥35岁比例高于非PH组[44.4%(8/18)比16.2%(11/68),44.4%(8/18)比13.2%(9/68)],差异有统计学意义(P<0.05)。PH组早产儿室间隔缺损、存在早发性PH比例高于非PH组[11.1%(2/18)比1.5%(1/68),77.8%(14/18)比51.5%(35/68)],呼吸机使用天数、用氧天数、住院天数均长于非PH组[58.5(42.0,74.0)d比39.0(30.0,51.8)d,62.0(42.8,82.5)d比45.5(38.3,57.5)d,(79.2±16.5)d比(67.9±18.9)d],差异有统计学意义(P<0.05)。Logistic回归分析显示,呼吸机使用天数、用氧天数及母亲年龄≥35岁是BPD极早产儿发生PH的独立危险因素(P<0.05)。结论BPD相关性PH极早产儿具有胎龄小、出生体重低、BPD程度重、母亲年龄≥35岁、合并室间隔缺损、早发性PH以及呼吸机使用天数和用氧天数显著延长的临床特点。呼吸机使用天数和用氧天数长、母亲年龄≥35岁是极早产儿BPD相关性PH的独立危险因素。

Objective To study the clinical features and risk factors of pulmonary hypertension(PH)associated with bronchopulmonary dysplasia(BPD)in very premature infants.Method From January 2016 to December 2018,preterm infants with gestational age of less than 32 weeks and diagnosed of BPD admitted to NICU of our hospital were reviewed.According to the results of Doppler echocardiography performed 28 d after birth,the infants were assigned into PH group and non-PH group.The demographic data of the two groups,maternal conditions during pregnancy,the results of Doppler echocardiography,complications,treatments,hospitalization duration and other indicators were analyzed.Result A total of 86 preterm infants with BPD were included.18 cases were in the PH group and 68 cases in the non-PH group.The gestational age and birth weight of PH group were lower than the non-PH group[(28.0±1.2)w vs.(28.8±1.5)w,975(875,1151)g vs.1172(954,1374)g].The incidences of severe BPD and mother’s age≥35 in the PH group were higher than the non-PH group[44.4%(8/18)vs.16.2%(11/68),44.4%(8/18)vs.13.2%(9/68)].The differences were statistically significant(P<0.05).The incidences of ventricular septal defect and early-onset PH were higher than the non-PH group[11.1%(2/18)vs.1.5%(1/68),77.8%(14/18)vs.51.5%(35/68)].The durations of ventilator use,oxygen use and hospitalization in the PH group were longer than the non-PH group[58.5(42.0,74.0)d vs.39.0(30.0,51.8)d,62.0(42.8,82.5)d vs.45.5(38.3,57.5)d,(79.2±16.5)d vs.(67.9±18.9)d],the differences were statistically significant(P<0.05).Logistic regression analysis showed that durations of ventilator and oxygen use and maternal age≥35 were independent risk factors for PH in very preterm infants with BPD(P<0.05).Conclusion Very premature infants with BPD-related PH have the clinical characteristics including small gestational age,low birth weight,severe degree of BPD,maternal age≥35,ventricular septal defect,early-onset PH,prolonged duration of mechanical ventilation and oxygen therapy.The duration of ventilator and oxygen use,and maternal age≥35 were independent risk factors for BPD related PH in very premature infants.