早产儿呼吸窘迫综合征并发肺出血的危险因素分析

Risk factors of respiratory distress syndrome complicated by pulmonary hemorrhage in premature infants

目的探讨早产儿呼吸窘迫综合征(RDS)并发肺出血(PH)的危险因素。方法选取昆明市儿童医院新生儿科2015年1月至2021年7月收治的胎龄<37周、确诊为RDS的患儿102例进行分析。根据PH的诊断标准,将患儿分为PH组和非PH组,采用t检验、非参数检验或χ^(2)检验比较两组患儿的临床资料,分析发生PH的危险因素,通过多因素logistic回归分析得出早产儿RDS并发PH的独立危险因素。结果共收集RDS早产儿102例,其中PH组51例,非PH组51例。PH组、非PH组出生胎龄分别为(32.3±3.0)周、(31.6±3.0)周,男性分别为36例(70.6%)、33例(64.7%),差异均无统计学意义(均P>0.05)。PH组胎龄<32周、合并动脉导管未闭(PDA)、RDS 3~4级的发生率明显高于非PH组[52.9%(27/51)比31.3%(16/51)、90.5%(38/42)比70.0%(35/50)、80.4%(41/51)比23.5%(12/51)](χ^(2)=5.29、4.66、33.03,均P<0.05)。多因素logistic回归分析发现,RDS 3~4级是独立危险因素(OR=9.83,95%CI:3.545~27.265,P<0.05)。PH组患儿机械通气时间≥7 d的比例较非PH组高[56.9%(29/51)比31.4%(16/51)],差异有统计学意义(χ^(2)=6.72,P<0.05)。结论胎龄<32周、合并PDA、RDS 3~4级是RDS患儿发生PH的危险因素,其中RDS 3~4级是独立危险因素。

Objective To investigate the risk factors of respiratory distress syndrome(RDS)complicated by pulmonary hemorrhage(PH)in premature infants.Methods A total of 102 infant patients with RDS whose gestational age was<37 weeks received treatment in the Department of Neonatology,Kunming Children's Hospital(Children's Hospital Affiliated to Kunming Medical University)from January 2015 to July 2021 and were included in this study.According to the diagnostic criteria of PH,these infant patients were divided into a PH group and a non-PH group.The clinical data of the two groups were compared using a t-test,non-parametric test,orχ^(2)test.The risk factors of PH were analyzed.The independent risk factors of RDS complicated by PH in premature infants were determined using multivariate logistic regression analysis.Results A total of 102 premature infants with RDS were collected,including 51 in the PH group and 51 in the non-PH group.The gestational ages at birth were(32.3±3.0)weeks and(31.6±3.0)weeks in the PH and non-PH groups,respectively.There were 36 males(70.6%)and 33 males(64.7%)in the PH and non-PH groups,respectively.There were no significant differences in proportion of males and gestational ages at birth between the two groups(both P>0.05).The incidence of gestational age<32 weeks[52.9%(27/51)vs.31.3%(16/51)],PH and RDS complicated by patent ductus arteriosus[90.5%(38/42)vs.70.0%(35/50)],and RDS grade 3-4[80.4%(41/51)vs.23.5%(12/51)]in the PH group were significantly higher than those in the non-PH group(χ^(2)=5.29,4.66,33.03,all P<0.05).Multivariate logistic regression analysis showed that RDS grade 3-4 was an independent risk factor of RDS complicated by PH(OR=9.83,95%CI:3.545-27.265,P<0.05).The proportion of infants with mechanical ventilation time≥7 days in the PH group was significantly higher than that in the non-PH group[56.9%(29/51)vs.31.4%(16/51),χ^(2)=6.72,P<0.05].Conclusion Gestational age<32 weeks,PH and RDS complicated by patent ductus arteriosus,and RDS grade 3-4 are the risk factors of PH in premature infants with RDS.RDS grade 3-4 is an independent risk factor.