早产儿支气管肺发育不良的危险因素及预后分析

Risk factors and prognosis of bronchopulmonary dysplasia in premature infants

目的 分析早产儿支气管肺发育不良(BPD)的危险因素和预后情况。方法 选择2018年8月至2021年6月期间广东省第二人民医院新生儿科收治的128例合并BPD的早产儿纳入观察组,选择同期未合并BPD的128例早产儿纳入对照组。比较两组早产儿的临床资料,并进一步应用多因素Logistic回归分析确定BPD的危险因素,分析随访1年时BPD早产儿的预后情况。结果 两组早产儿在母亲年龄、新生儿性别方面比较差异均无统计学意义(P>0.05);观察组母亲先兆子痫、1 min Apgar<7分、宫内窘迫、宫内感染、新生儿呼吸窘迫综合征(NRDS)、机械通气≥7 d、使用肺表面活性物质和碳青霉烯类抗生素的比例分别为27.34%、69.53%、20.31%、29.69%、73.44%、60.94%、100.00%、33.59%,吸氧时间为(40.14±12.20) d,明显高于对照组的9.38%、10.16%、6.25%、14.84%、16.41%、13.28%、92.97%、14.83%、(27.95±6.29) d,差异均有统计学意义(P<0.05);观察组早产儿胎龄及出生体质量、血红蛋白分别为(30.34±1.01)周、(1.61±0.54) kg、(141.02±29.22) g/L,明显低于对照组的(31.12±0.82)周、(1.98±0.61) kg、(148.63±3.28) g/L,差异均有统计学意义(P<0.05);经多因素Logistic回归分析结果显示,先兆子痫、胎龄、机械通气时间为早产儿发生BPD的独立危险因素(P<0.05);BPD早产儿住院期间的病死率为4.69%,一年总的病死率为8.59%。结论 早产儿支气管肺发育不良的预后不佳,其发生与先兆子痫、胎龄、使用碳青霉烯类抗生素、机械通气时间等多种危险因素密切相关,临床上应根据BPD的危险因素进行针对性的防治。

Objective To investigate the risk factors and prognosis of bronchopulmonary dysplasia(BPD) in premature infants. Methods A total of 128 premature infants with BPD treated in Department of Neonatology, Guangdong Second Provincial General Hospital from August 2018 to June 2021 were enrolled in the observation group, and128 premature infants without BPD were included into the control group. The clinical data between the two groups were compared, and the risk factors of static BPD were determined by multivariate Logistic regression analysis. The infants were followed up for 1 year, and the prognosis was recorded. Results There was no significant difference in maternal age and neonatal gender between the two group(P>0.05). The proportions of maternal preeclampsia, 1 min Apgar < 7,intrauterine distress, intrauterine infection, neonatal respiratory distress syndrome(NRDS), mechanical ventilation≥7 d,pulmonary surfactant(PS) and Carbapenem antibiotics use in the observation group were 27.34%, 69.53%, 20.31%,29.69%, 73.44%, 60.94%, 100.00%, 33.59%, and oxygen inhalation time was(40.14±12.20) d, respectively, significantly higher than 9.38%, 10.16%, 6.25%, 14.84%, 16.41%, 13.28%, 92.97%,14.83%, and(27.95±6.29) d in the control group(P<0.05). The gestational age, birth weight, hemoglobin in the observation group were(30.34±1.01) weeks,(1.61±0.54) kg,(141.02±29.22) g/L, which were significantly lower than(31.12±0.82) weeks,(1.98±0.61) kg,(148.63±3.28) g/L in the control group(P<0.05). Multivariate Logistic regression analysis showed that preeclampsia, gestational age and mechanical ventilation time were independent risk factors for BPD in preterm infants(P<0.05). The mortality of children with BPD during hospitalization was 4.69%, and the total mortality in one year was 8.59%. Conclusion The prognosis of bronchopulmonary dysplasia in preterm infants is poor. Its occurrence is closely related to many risk factors such as preeclampsia, gestational age, Carbapenem antibiotics, and mechanical ventilation time. Clinically, targeted prevention and treatment should be applied according to the risk factors of BPD.