支气管肺发育不良的超低出生体重儿能量和液量供应情况分析

Analysis of Energy and Fluid Supply in Very Low Birth Weight Infants with Bronchopulmonary Dysplasia

目的:了解我院超低出生体重儿(ELBWI)住院期间能量、液量的供应以及支气管肺发育不良(BPD)发生的现况。方法:将我院2018年1月—2020年2月收治的ELBWI 120例作为研究对象,按照BPD发生情况分成三组,即无BPD组、轻度BPD组和中重度BPD组,回顾性分析其住院期间的能量和液量供应情况、BPD的发生率和主要诊疗、并发症等。结果:(1)最终纳入分析的早产儿共91例,其中无BPD组14例,轻度BPD组46例,中重度BPD组31例,BPD发生率84.6%(77/91)。无BPD组ELBWI胎龄大于轻度和中重度BPD组,无BPD组体重Z评分≤-2占比及SGA占比高于轻度和中重度BPD组,差异有统计学意义(P<0.05);(2)无BPD组的总液量在D7、D14、D21、D28均高于另外两组,无BPD组的总热卡和肠内热卡在D14、D21、D28均高于中重度BPD组,轻度BPD组D14、D28总热卡均高于中重度BPD组,差异有统计学意义(P<0.05);(3)和无BPD和轻度BPD组相比,中重度BPD组ELBWI有创和无创通气时间、使用抗生素和激素时间均较长,PDA超过2周不闭合及使用布洛芬、患呼吸机相关性肺炎(VAP)人数占比高,最高吸入氧浓度高,输血次数多,体重增长慢,差异有统计学意义(P<0.05);(4)D14总液量多、D21肠内营养热卡高可能是轻度BPD的保护因素,有创通气是轻度和中重度BPD发生的危险因素。结论:我院ELBWI住院期间总液量基本符合指南要求,但总热卡尤其是肠内热卡供应偏低,D14总液量多、D21肠内营养热卡高可能是轻度BPD的保护因素。

Objective:To investigate the status of energy and fluid supply,the incidence of bronchopulmonary dysplasia(BPD)in extremely low birth weight infants(ELBWI)during hospitalization.Methods:From January 2018 to February 2020,ELBWI admitted to our hospital were divided into three groups:no BPD group,mild BPD group and moderate or severe BPD group.The energy and fluid supply,incidence of BPD,main diagnosis and treatment,and complications during hospitalization were analyzed retrospectively.Results:(1)91 premature infants were analysed,including 14 in no BPD group,46 in mild BPD group and 31 in moderate and severe BPD group.The incidence of BPD was 84.6%(77/91).The gestational age in no BPD group was higher than that in mild and moderate to severe BPD group,the proportion of body weight Z score≤-2 and SGA in the group without BPD were higher than those in the mild and moderate and severe BPD groups,and the difference was statistically significant(P<0.05).(2)The total fluid volume of the no BPD group in D7,D14,D21,and D28 were higher than the other two BPD groups.The total calories and enteral calories of the no BPD group were higher than those of the moderate to severe BPD group in D14,D21,and D28.The total calories of the mild BPD group in D14 and D28 were both higher than those of the moderate to severe BPD group(P<0.05).(3)Compared with the no BPD and mild BPD group,the moderate to severe BPD group had longer time of invasive and noninvasive ventilation,PDA more than 2 weeks of non-closure,use of ibuprofen and patients with ventilator-associated pneumonia(VAP)accounted for a high proportion,the highest inhaled oxygen concentration was higher,the number of blood transfusions was more,and the weight gain was slower,the difference was statistically significant(P<0.05).(4)Higher total fluid volume of D14 and enteral calorie value of D21 may be the protective factors for mild BPD,and invasive ventilation may be the risk factor for mild and moderately severe BPD.Conclusion:The total fluid volume of ELBWI during hospitalizaton basically meets the requirements of the guidelines,but the supply of total calorie,especially enteral calorie is low.Higher total fluid volume in D14 and higher enteral nutrition calorie in D21 may be the protective factors for mild BPD.