新生儿呼吸窘迫综合征极低出生体重儿并发支气管肺发育不良高危因素分析

Analysis of high-risk factors of neonatal respiratory distress syndrome in very low birth weight infants with bronchopulmonary dysplasia

目的 探讨研究新生儿呼吸窘迫综合征极低出生体重儿并发支气管肺发育不良的高危因素。方法 选取2017年4月至2019年4月在秦皇岛市妇幼保健院接受治疗的80例新生儿呼吸窘迫综合征极低出生体重儿为研究对象,根据患儿是否并发支气管肺发育不良分为两组,并发支气管肺发育不良为并发组,共48例,未并发支气管肺发育不良的为未并发组,共32例,记录胎儿出生时情况:出生体重、是否试管婴儿、性别、是否多胎、出生胎龄、1min和5minApgar评分;记录孕妇状况:产前激素使用情况、妊娠期高血压情况、妊娠期糖尿病情况、胎膜早破史;记录检查和治疗情况:输注红细胞悬液情况、抗生素使用时间、使用机械通气情况、住院天数、吸入氧气浓度40%及以上、肺表面活性物质、痰培养阳性和机械通气7天及以上情况;记录并发症发生情况:乳糖不耐受、动脉导管未闭、颅内出血、败血症、肺出血、肺动脉高压、颅内感染、呼吸暂停、消化道出血、新生儿坏死性小肠结肠炎、新生儿窒息和早发败血症等。结果 80例胎儿中并发组48例,支气管肺发育不良并发率为60.00%,其中轻度32例,占比为66.67%,中度5例,占比为10.42%,重度11例,占比为22.91%。并发组胎儿住院天数高于未并发组,差异有统计学意义(P<0.05),两组性别、出生胎龄、妊娠期糖尿病、1minApgar评分、妊娠期高血压、5minApgar评分、产前激素、试管婴儿、胎膜早破史、出生体重和多胎差异无统计学意义(P>0.05);两组机械通气≥7天、抗生素使用天数、吸入氧浓度≥40%、输注红细胞悬液差异有统计学意义(P<0.05),两组持续气道正压通气≥14天、机械通气、肺表面活性物质、痰培养阳性差异无统计学意义(P>0.05);并发组胎儿更易发生消化道出血、肺出血、肺动脉高压、动脉导管未闭疾病,两组间差异有统计学意义(P<0.05),两组颅内出血、新生儿坏死性小肠结肠炎、呼吸暂停、颅内感染、乳糖不耐受、新生儿窒息、早发败血症、败血症差异无统计学意义(P>0.05);机械通气≥7天、肺动脉高压、输注红细胞悬液、吸入氧浓度≥40%是新生儿呼吸窘迫综合征极低出生体重儿并发支气管肺发育不良的高危因素。结论 临床治疗新生儿呼吸窘迫综合征极低出生体重儿时要注意输血指针,积极预防肺动脉高压,尽最大可能避免长时间机械通气,控制降低氧疗浓度,这样可以有效避免并发支气管肺发育不良疾病。

Objective To explore the high-risk factors of neonatal respiratory distress syndrome in very low birth weight infants with bronchopulmonary dysplasia.Methods 80cases of very low birth weight infants with neonatal respiratory distress syndrome who were treated in our hospital from April 2017to April 2019were selected as the research objects.According to whether the children were complicated with bronchopulmonary dysplasia,they were divided into two groups,with bronchopulmonary dysplasia.The dysplasia is in the concurrent group,48cases in total,and the non-complicated bronchopulmonary dysplasia is in the non-complicated group,with 32cases in total.Record the fetus at birth:birth weight,test-tube baby,gender,multiple births,gestational age at birth,1min and 5minApgar score;record the status of pregnant women:prenatal hormone use,gestational hypertension,gestational diabetes,history of premature rupture of membranes;record examination and treatment:infusion of red blood cell suspension,antibiotic use time,use of mechanical ventilation Conditions,days of hospitalization,inhaled oxygen concentration of 40% or more,pulmonary surfactant,positive sputum culture,and mechanical ventilation for 7days or more;record the occurrence of complications:lactose intolerance,patent ductus arteriosus,intracranial hemorrhage,sepsis,Pulmonary hemorrhage,pulmonary hypertension,intracranial infection,apnea,gastrointestinal hemorrhage,neonatal necrotizing enterocolitis,neonatal asphyxia and early sepsis.Results There were 48cases in the concurrent group of 80fetuses.The incidence of bronchopulmonary dysplasia was 60.00%,of which 32cases were mild,accounting for 66.67%,5cases were moderate,accounting for 10.42%,and 11cases were severe,accounting for 22.91%.The number of fetal hospitalization days in the concurrent group was higher than that in the non-complicated group,(P<0.05).The two groups’ gender,gestational age at birth,gestational diabetes,1minApgar score,gestational hypertension,5minApgar score,prenatal hormones,test tube There were no statistically significant differences in infants,history of premature rupture of membranes,birth weight,and multiple births(P>0.05);there were statistical differences between the two groups of mechanical ventilation for≥7days,antibiotic use days,inhaled oxygen concentration≥40%,and red blood cell suspension infusion Significance(P<0.05).There was no statistically significant difference between the two groups of continuous positive airway pressure for≥14days,mechanical ventilation,lung surfactant,and positive sputum culture(P>0.05);the fetus in the concurrent group was more likely to have gastrointestinal bleeding,Pulmonary hemorrhage,pulmonary hypertension,patent ductus arteriosus disease(P<0.05),the two groups of intracranial hemorrhage,neonatal necrotizing enterocolitis,apnea,intracranial infection,lactose intolerance There was no statistically significant difference in susceptibility,neonatal asphyxia,early-onset sepsis,and sepsis(P>0.05);mechanical ventilation for≥7days,pulmonary hypertension,infusion of red blood cell suspension,and inhaled oxygen concentration≥40% are neonatal respiratory distress syndrome Very low birth weight infants with high risk factors for bronchopulmonary dysplasia.Conclusion Clinical treatment of neonatal respiratory distress syndrome and very low birth weight infants should pay attention to blood transfusion indicators,actively prevent pulmonary hypertension,avoid prolonged mechanical ventilation as much as possible,and control and reduce the concentration of oxygen therapy,which can effectively avoid complications of bronchopulmonary dysplasia.