胎龄<32周有血流动力学意义的动脉导管未闭早产儿危险因素及并发症分析

Risk factors and complication of hemodynamically significant patent ductus arteriosus in preterm infants with gestational age<32 weeks

目的探讨<32周早产儿有血流动力学意义的动脉导管未闭(hemodynamically significant patent ductus arteriosus,hsPDA)的危险因素及并发症。方法对2021年1月至2022年3月入住聊城市人民医院重症监护室的胎龄<32周的早产儿进行回顾性分析,共150例,排除不符合要求的9例,最后纳入141例,其中PDA组95例,非PDA组46例。PDA组又按照有无hsPDA分为hsPDA组42例,非hsPDA组53例。采用单因素及回归分析研究胎龄<32周早产儿发生hsPDA的危险因素及并发症。结果单因素分析显示,胎龄<32周早产儿hsPDA危险因素有胎龄(t=-6.861,P<0.01)、体重(t=-4.392,P<0.01)、分娩方式(χ^(2)=9.018,P<0.01)、咖啡因应用(χ^(2)=4.337,P<0.05)及有无窒息(χ^(2)=7.918,P<0.01);回归分析显示胎龄是<32周早产儿发生hsPDA的独立危险因素(OR=2.435,P<0.01,95%CI 1.669~3.552)。hsPDA组发生坏死性小肠结肠炎、脑室内出血、支气管肺发育不良、早产儿视网膜病均高于非hsPDA组患儿(P<0.05)。结论胎龄是<32周早产儿发生hsPDA的独立危险因素,坏死性小肠结肠炎、脑室内出血、支气管肺发育不良、早产儿视网膜病为hsPDA的相关并发症。

Objective To study the risk factors and complications of hemodynamically significant patent ductus arteriosus(hsPDA)in preterm infants<32 weeks.Methods From January 2021 to March 2022,a total of 150 premature infants with gestational age<32 weeks admitted to the Neonatal Intensive Care Unit of Liaocheng People′s Hospital were enrolled.Nine patients who did not meet the requirements were excluded and a total of 141 infants were finally analyzed retrospectively,including PDA group with 95 cases and non-PDA group with 46 cases.According to whether hsPDA existed or not,PDA group were dirided into hsPDA group with 42 cases and non-hsPDA group with 53 cases.Univariate and regression analyses were used to determine the risk factors and complication of hsPDA.Results Univariate analysis showed that gestational age(t=-6.861,P<0.01),birth weight(t=-4.392,P<0.01),mode of delivery(χ^(2)=9.018,P<0.01),caffeine(χ^(2)=4.337,P<0.05)and suffocation(χ^(2)=7.918,P<0.01)were associated with hsPDA.Logistic regression analysis showed that gestational age(OR=2.435,P<0.01,95%CI:1.669~3.552)was an independent risk factor for hsPDA in gestational age<32 weeks preterm infants.The incidences of necrotizing enterocolitis,intraventricular hemorrhage,bronchopulmonary dysplasia,and retinopathy of prematurity in the hsPDA group were higher than those in the non-hsPDA group(P<0.05).Conclusion Gestational age is an independent risk factor for hsPDA with gestational age<32 weeks.Necrotizing enterocolitis,intraventricular hemorrhage,bronchopulmonary dysplasia,and retinopathy of prematurity are related complications of hsPDA.