低血压对胎龄<32周早产儿近期预后的影响

Influence of hypotension on the short-term prognosis of preterm infants with a gestational age of<32 weeks

目的探讨以平均动脉压(mean arterial pressure,MAP)<胎龄(周)和MAP<30 mmHg定义为低血压的2种定义的早期低血压对胎龄<32周早产儿近期预后的影响。方法前瞻性纳入华中科技大学同济医学院附属湖北妇幼保健院2020年4月—2021年8月收治的符合纳入标准的早产儿320例,监测生后72 h内血压。低血压的定义与分组采取以下2种方式:(1)连续2次MAP<胎龄者为低血压组(n=104),其余病例为对照组(n=216);(2)连续2次MAP<30 mmHg者为低血压组(n=114),其余病例为对照组(n=206)。收集患儿围生期资料及住院期间的临床资料。近期预后不良定义为住院期间死亡和/或出生1周内发生Ⅲ~Ⅳ度脑室周围-脑室内出血。采用多因素logistic回归分析法评估上述2种定义下的低血压对近期预后的影响。结果2种定义下的低血压组低灌注临床表现、预后不良、有血流动力学意义的动脉导管未闭、肺出血的发生率均高于对照组,差异有统计学意义(均P<0.05)。此外,MAP<30 mmHg定义下的低血压组脑室周围-脑室内出血、支气管肺发育不良的发生率及住院期间病死率高于对照组,差异有统计学意义(P<0.05)。MAP<30 mmHg定义下的低血压组近期预后不良发生率高于MAP<胎龄定义下的低血压组(18.4%vs 12.5%),但差异无统计学意义(P>0.05)。单因素分析显示,近期预后不良与剖宫产出生、胎龄、5 min Apgar评分≤5分、生后72 h内使用血管活性药物、生后72 h内机械通气及2种定义下的低血压有关(P<0.05)。多因素logistic回归分析显示,2种定义下的低血压均非近期预后不良的独立危险因素(P>0.05)。结论2种定义下的低血压均非胎龄<32周早产儿近期预后不良的独立危险因素;MAP<30 mmHg定义下的低血压较MAP<胎龄定义下的低血压在预测近期不良结局时可能呈现敏感性更高的趋势,有待大样本研究进一步分析。

Objective To investigate the influence of early-stage hypotension defined as mean arterial pressure(MAP)<gestational age(weeks)or MAP<30 mmHg on the short-term prognosis of preterm infants with a gestational age of<32 weeks.Methods A total of 320 preterm infants who were admitted to Maternal and Child Health Hospital of Hubei Province,Tongji Medical College,Huazhong University of Science and Technology from April 2020 to August 2021 and met the inclusion criteria were enrolled in this prospective study.Blood pressure within 72 hours was monitored.The definition of hypotension and grouping were as follows:(1)Of the 320 preterm infants,those with MAP<gestational age in 2 consecutive measurements served as the hypotension group(n=104),and the others(n=216)served as the control group;(2)Of the 320 preterm infants,those with MAP<30 mmHg in 2 consecutive measurements served as the hypotension group(n=114),and the others served as the control group(n=206).Perinatal data and clinical data during hospitalization were collected.Poor short-term prognosis was defined as death during hospitalization and/or gradeⅢ-Ⅳperiventricular-intraventricular hemorrhage identified within 1 week after birth.The multivariate logistic regression analysis was used to investigate the influence of hypotension based on the above two definitions on the short term prognosis of preterm infants.Results Compared with the control group,the hypotension group based on the above two definitions had higher incidence rates of the clinical manifestations of hypoperfusion,poor prognosis,hemodynamically significant patent ductus arteriosus,and pulmonary hemorrhage(P<0.05).In addition,compared with the control group,the hypotension group defined by MAP<30 mmHg had higher incidence rates of periventricular intraventricular hemorrhage and bronchopulmonary dysplasia and mortality rate during hospitalization(P<0.05).The incidence of poor short-term prognosis in the hypotension group defined by MAP<30 mmHg was higher than that in the hypotension group defined by MAP<gestational age(18.4%vs 12.5%),but the difference was not statistically significant(P>0.05).The univariate analysis showed that the poor short-term prognosis was related to birth of cesarean section,gestational age,an Apgar score of≤5 at 5 minutes,use of vasoactive drugs within 72 hours,mechanical ventilation within 72 hours,and hypotension under the two definitions(P<0.05).The multivariate logistic regression showed that hypotension based on either definition was not an independent risk factor for poor prognosis(P>0.05).Conclusions Hypotension based on either definition is not an independent risk factor for short-term poor prognosis in preterm infants with a gestational age of<32 weeks.Hypotension defined by MAP<30 mmHg might be more sensitive than that defined by MAP<gestational age in predicting short-term adverse outcomes,which needs further analysis by large sample studies.