早产儿贫血与输血治疗相关因素分析

Analysis of anemia-related factors and transfusion status in premature infants

目的分析引起早产儿贫血的相关危险因素及输血现状。方法收集本院2018年8月~2019年7月收治的日龄≤48 h入院且住院时间≥7 d的早产儿临床资料。根据血红蛋白值分为贫血组与非贫血组,比较2组的一般资料、住院期间疾病发生情况及治疗措施,并分析影响贫血的危险因素。结果本研究共纳入169例,其中贫血组88例,非贫血组81例。2组间辅助生殖受孕[47(53.409%)vs 33(40.741%),P<0.05]、基础血红蛋白值[180.395(176.282,184.508)vs 162.841(158.596,167.085),P<0.05]、母孕期贫血[27(30.682%)vs 12(14.815%),P<0.05]、晚发型败血症[64(72.727%)vs 31(38.272%),P<0.05]、机械通气治疗[46(52.273%)vs 10(12.346%),P<0.05]、新生儿呼吸窘迫综合征[51(57.955%)vs 26(32.099%),P<0.05]、凝血功能异常[27(30.682%)vs 11(13.580%),P<0.05]及平均住院天数[31.276(26.885,35.666)vs 15.798(14.251,17.344),P<0.05]差异均有统计学意义。多因素Logistic结果显示,辅助生殖、母孕期贫血、有创机械通气治疗、凝血功能异常及平均住院天数≥20 d为危险因素。住院期间输注红细胞纠正贫血的患儿共40例(23.669%),其中极低出生体重儿21例。极低出生体重儿住院期间行红细胞输注次数≥3次8例(45.2%),多次输注组(输红细胞≥3次)支气管肺发育不良发生率高于非多次输注组。结论产母妊娠期贫血、辅助生殖受孕、机械通气治疗、凝血功能异常及平均住院天数≥20 d均是影响贫血发生的相关因素。支气管肺发育不良的发生可能与多次输血存在相关性,但尚无明确证据证明输血是支气管肺发育不良发展的独立危险因素,还需要大样本、多中心的研究。

Objective To analyze the risk factors of anemia in premature infants and the status of blood transfusion.Methods Clinical data of preterm infants with age≤48 hours and hospitalization time≥7 days,admitted to our hospital from August 2018 to July 2019,were collected.According to the Hb value,they were divided into the anemia group and the non-anemia group.The general information,disease occurrence,and treatment measures during hospitalization of the two groups were compared,and the risk factors affecting anemia were analyzed.Results A total of 169 cases were included in this study,including 88 cases in the anemia group and 81 cases in the non-anemia group.There were statistically significant differences between two groups in assisted reproduction 47(53.409)vs 33(40.741),basic Hb value 180.395(176.282,184.508)vs 162.841(158.596,167.085),maternal pregnancy anemia 27(30.682)vs 12(14.815),late-onset sepsis(LOS)64(72.727)vs 31(38.272),mechanical ventilation 46(52.273)vs 10(12.346),neonatal respiratory distress syndrome(NRDS)51(57.955)vs 26(32.099),coagulation dysfunction 27(30.682)vs 11(13.580)and average hospitalization days 31.276(26.885,35.666)vs 15.798(14.251,17.344),all P<0.05.Multivariate logistic results showed assisted reproduction,maternal pregnancy anemia,mechanical ventilation,coagulation dysfunction and average hospitalization days≥20 were risk factors for preterm anemia.A total of 40 cases(23.669%)needed RBC transfusion to correct anemia during hospitalization,including 21 cases of very low birth weight infants(VLBWI).8 patients(38.095%)received RBC transfusion≥3 times during VLBWI hospitalization.The incidence of bronchopulmonary dysplasia(BPD)in the multiple transfusion group(≥3 times of RBC transfusion)was higher than in the non-multiple transfusion group.Conclusion Maternal anemia during pregnancy,assisted reproduction,mechanical ventilation,coagulation dysfunction and average hospitalization days are the related factors affecting the occurrence of anemia.The occurrence of BPD may be associated with multiple blood transfusions,but there is no clear evidence to prove that blood transfusion is an independent risk factor for the development of BPD,and a large sample,multi-center study is needed.