极低出生体重儿发生肺出血的危险因素及其临床转归

Pulmonary hemorrhage in very low birth weight infants: risk factors and clinical outcome

目的 研究极低出生体重儿(very low birth weight infant,VLBWI)发生肺出血的高危因素及其临床转归。方法 病例来源于2020年1月1日至2021年12月31日江苏省妇幼保健院和南京医科大学附属儿童医院收治的所有活产VLBWI (胎龄<35周),符合纳入和排除标准的574例VLBWI进入研究,其中肺出血组44例,无肺出血组530例。收集2组临床资料进行比较分析,采用多因素logistic回归分析探讨肺出血的危险因素。结果 肺出血组和无肺出血组母亲年龄、正压通气复苏率、气管插管复苏率和生后1h内最低体温的比较差异有统计学意义(P<0.05)。肺出血组Ⅲ~Ⅳ级呼吸窘迫综合征和早发型败血症的比例高于无肺出血组(P<0.05)。生后1h内毛细血管再充盈时间>3 s和生后24 h内最大呼气末正压(positive end-expiratory pressure,PEEP)<5 cm H2O的患儿在肺出血组更常见(P<0.05)。多因素logistic回归分析显示,母亲年龄30~<35岁为肺出血的保护因素(OR=0.115,P<0.05),而生后1h内最低体温<34℃、生后24h内最大PEEP<5 cm H2O和早发型败血症是肺出血发生的危险因素(OR值分别为11.609、11.118和20.661,均P<0.05)。在所有病例中,肺出血组有创通气总时间长于无肺出血组(P<0.05),病死率高于无肺出血组(P<0.05);在存活病例中,肺出血组支气管肺发育不良的发生率高于无肺出血组(P<0.05)。结论 VLBWI生后注意保温、给予合适PEEP和早期识别败血症可减少肺出血的发生,从而有助于减少支气管肺发育不良的发生和降低病死率。

Objective To investigate the risk factors for pulmonary hemorrhage and its clinical outcome in very low birth weight infants(VLBWIs).Methods The medical data were collected from all live VLBWIs(gestational age <35 weeks) who were admitted to Jiangsu Women and Children Health Hospital and Children’s Hospital of Nanjing Medical University between January 1,2020 and December 31,2021.Based on inclusion and exclusion criteria,574 VLBWIs were included in the study,with 44 VLBWIs in the pulmonary hemorrhage group and 530 VLBWIs in the nonpulmonary hemorrhage group.The clinical data were compared between the two groups.A multivariate logistic regression analysis was used to identify the risk factors for pulmonary hemorrhage.Results There were significant differences between the two groups in maternal age,rate of positive-pressure ventilation for resuscitation,rate of tracheal intubation for resuscitation,and minimum body temperature within 1 hour after birth(P<0.05).The pulmonary hemorrhage group had a higher proportion of VLBWIs with grade Ⅲ-Ⅳ respiratory distress syndrome or early-onset sepsis than the non-pulmonary hemorrhage group(P<0.05).The pulmonary hemorrhage group also had a higher proportion of VLBWIs with a capillary refilling time of>3 seconds within 1 hour after birth and with the maximum positive end-expiratory pressure(PEEP) of <5 cmHO within 24 hours after birth(P<0.05).The multivariate regression analysis showed that maternal age of 30-<35 years(OR=0.115,P<0.05) was a protective factor against pulmonary hemorrhage,while a lower temperature(<34℃) within 1 hour after birth,the maximum PEEP of <5 cm HO within 24 hours after birth,and early-onset sepsis were risk factors for pulmonary hemorrhage(OR=11.609,11.118,and 20.661,respectively;P<0.05).For all VLBWIs,the pulmonary hemorrhage group had a longer duration of invasive ventilation and a higher mortality rate than the non-pulmonary hemorrhage group(P<0.05);for the survival VLBWIs,the pulmonary hemorrhage group had a higher incidence rate of bronchopulmonary dysplasia than the non-pulmonary hemorrhage group(P<0.05).Conclusions Maintaining the stability of temperature,giving appropriate PEEP,and identifying sepsis as early as possible can reduce the incidence rate of pulmonary hemorrhage,thereby helping to reduce the incidence of bronchopulmonary dysplasia and mortality in VLBWIs.