极低出生体重儿输血的危险因素分析

Risk factors for blood transfusion in very low birth weight infants

目的探讨极低出生体重儿(VLBWI)输血情况及危险因素。方法回顾性分析2016年7月至2019年6月我院收治的100例胎龄<37周且出生体重<1500 g的新生儿,根据是否输血分为输血组及未输血组,比较两组的一般资料、住院期间疾病发生情况及治疗措施,并分析影响输血的危险因素。结果100例VLBWI,69例需输血治疗(输血组),31例未输血(非输血组)。首次输血多在生后1~4周,平均输注次数为6次。两组患儿分别在母孕期贫血、出生体重、胎龄、出生时血红蛋白值及红细胞压积、生后2周内采血量、住院时间、肠外营养时间、分娩方式、出生后是否需气管插管及新生儿呼吸窘迫综合征、呼吸暂停、支气管肺发育不良、动脉导管未闭的发生方面差异有统计学意义(P均<0.05)。多因素Logistic回归分析显示,胎龄(OR=0.386,95%CI 0.212~0.704,P=0.002)越小、住院时间(OR=2.177,95%CI 1.170~4.049,P=0.014)及肠外营养时间(OR=1.195,95%CI 1.083~1.319,P<0.001)越长、生后2周内采血量越大(OR=1.269,95%CI 1.083~1.487,P=0.003)、剖宫产(OR=5.513,95%CI 1.056~28.770,P=0.043)的VLBWI输血率越高。结论VLBWI的胎龄、住院时间、生后2周内采血量、肠外营养时间及分娩方式均对输血风险存在不同程度的影响。

Objective To evaluate the characteristics and risk factors for blood transfusion in very low birth weight infants(VLBWI).Methods Clinical data of one hundred VLBWI,hospitalized from July,2016 to June,2019,were studied retrospectively.The infants were divided into two groups according to whether they received blood transfusion.The general information,incidence of diseases and treatment measures were compared between two groups.The risk factors influencing the blood transfusion were analyzed.Results Of the one hundred VLBWI,sixty-nine cases needed blood transfusion.The first time of blood transfusion ranged from one to four weeks after birth,and average number of transfusions was 6 times.Maternal anemia during pregnancy,birth weight,gestational age,hemoglobin and hematocrit at birth,volume of blood taking within two weeks after birth,duration of hospitalization,duration of paraenteral nutrition,delivery method,need for intubation and neonatal respiratory distress syndrome,apnea,bronchopulmonary dysplasia,patent ductus arteriosus showed significant differences between the two groups(P<0.05).Logistic regression analysis revealed that lower gestation(OR=0.386,95%CI 0.212-0.704,P=0.002),longer duration of hospital stay(OR=2.177,95%CI 1.170-4.049,P=0.014),prolonged parenteral nutrition(OR=1.195,95%CI 1.083-1.319,P<0.001),greater volume of blood taking within two weeks after birth(OR=1.269,95%CI 1.083-1.487,P=0.003)and cesarean delivery(OR=5.513,95%CI 1.056-28.770,P=0.043)were associated with increasing risk of blood transfusion in VLBWI.Conclusion The gestational age,length of hospital stay,blood intake within two weeks after birth,duration of paraenteral nutrition and delivery method all affected the risk of blood transfusion to varying degrees.