不同胎龄早产儿支气管肺发育不良的高危因素分析及临床随访

Analysis of high-risk factors and clinical follow-up of bronchopulmonary dysplasia in premature infants with different gestational ages

目的探讨不同胎龄早产儿支气管肺发育不良(BPD)的危险因素。方法采用回顾性分析方法收集不同胎龄确诊为BPD的早产儿95例为研究对象。根据胎龄分为超早产儿(<28周)16例、极早产儿(28~31+6周)62例、中晚期早产儿(32~36+6周)17例。分别对不同胎龄早产儿母亲孕期疾病史、产前使用激素情况及其患儿的性别、出生体质量、窒息、动脉导管未闭、用药情况、输血、机械通气时间、吸氧时间、住院时间等方面进行分析,并对部分患儿出院后进行随访。结果在不同胎龄BPD早产儿中,母亲妊娠期合并子痫前期对中晚期早产儿影响显著高于极早产儿组、超早产儿组,差异均有统计学意义(P<0.05)。超早产儿组使用呼吸机机械通气时间、吸氧时间、住院时间、动脉导管未闭发生率显著高于极早产儿组、中晚期早产儿组,差异有统计学意义(P<0.01)。中晚期早产儿组、超早产儿组肺炎发生率显著高于极早产儿组,差异有统计学意义(P<0.05)。随访的(6月至5岁之间)45例患儿中,发现部分患儿存在不同程度的生长发育迟缓、呼吸系统疾病、听力障碍、视力障碍、脑部发育异常,有5例患儿已死亡。结论早产儿BPD发生的因素存在多样性,胎龄越小其呼吸机使用时间越长、用氧时间越长,从而患有BPD的风险就会增加,其预后差,因此孕产妇应做好孕期保健,早产儿规范合理用药、用氧,采取肺保护性通气策略、积极综合支持治疗是预防BPD发生的关键。

Objective To investigate the risk factors of bronchopulmonary dysplasia(BPD)in premature infants with different gestational ages.Methods Ninety-five premature infants with different gestational ages diagnosed as BPD were retrospectively analyzed.According to gestational age,there were 16 cases of super premature infants(<28 weeks),62 cases of extremely premature infants(28-31+6 weeks),and 17 cases of middle and late premature infants(32-36+6 weeks).The history of disease during pregnancy,prenatal hormone use,and gender,birth weight,asphyxia,patent ductus arteriosus,medication,transfuse blood,mechanical ventilation time,oxygen inhalation time,hospitalization time of premature infants with different gestational ages were analyzed.Some children were followed up after discharge.Results Among BPD preterm infants with different gestational ages,the effect of maternal pregnancy with preeclampsia on middle and late preterm infants was significantly higher than that of extremely premature infants and super premature group,and the differences were statistically significant(P<0.05).The mechanical ventilation time of the super premature infants was significantly longer than that of the extremely premature infants and the middle and late premature infants,and the difference was statistically significant(P<0.01).The oxygen inhalation time of super preterm infants was significantly higher than that of extremely preterm infants and middle and late preterm infants,and the difference was statistically significant(P<0.01).The hospitalization time of super preterm infants were significantly higher than those of extremely preterm infants and middle and late preterm infants,and the difference was statistically significant(P<0.01).The incidence of patent ductus arteriosus in super preterm infants was significantly higher than that in extremely preterm infants and middle and late preterm infants,and the difference was statistically significant(P<0.01).The incidence of pneumonia in middle and late premature infants and super premature infants was significantly higher than that in extremely premature infants,and the difference was statistically significant(P<0.05).During the follow-up 45 children(between 6 months and 5 years old),it was found that some children had different degrees of growth retardation,respiratory diseases,hearing impairment,vision disorder and abnormal brain development,and 5 children died.Conclusions There is diversity in the factors that contribute to the occurrence of BPD in premature infants.The younger the gestational age,the longer the duration of mechanical ventilation and oxygen use,resulting in an increased risk of developing BPD and a poorer prognosis.Therefore,pregnant womem should do well in pregnancy and it is necessary to standardize rational drug use and oxygen use,adopt lung protective ventilation strategy,and actively and comprehensively support treatment for premature infants.