动脉导管未闭与极低出生体重早产儿支气管肺发育不良的相关性分析

Correlation of patent ductus arteriosus with bronchopulmonary dysplasia in very low birth weight preterm infants

目的探讨动脉导管未闭(PDA)分流方向及持续时间,与极低出生体重(VLBW)早产儿支气管肺发育不良(BPD)的相关性。方法选择2020年1月至2023年6月徐州医科大学附属医院收治的193例出生胎龄<32周,并且出生体重(BW)<1500 g的PDA VLBW早产儿为研究对象。采取回顾性分析方法,根据出生7 d后的超声心动图结果,将其分为无血流动力学意义的PDA(nhsPDA)组(n=89)、有血流动力学意义的PDA左向右分流(hsPDA-lr)组(n=65)和有血流动力学意义的PDA右向左/双向分流(hsPDA-rl/bd)组(n=39)。对3组PDA VLBW早产儿一般临床资料、并发症发生率及治疗疗效进行统计学比较。采用单因素logistic及多因素非条件logistic回归分析法,对影响本组PDA VLBW早产儿发生BPD及BPD(2~3级)的独立危险因素进行分析。本研究经徐州医科大学附属医院伦理委员会审批(审批文号:XYFY2022-KL302-01),并与所有早产儿监护人签署临床研究知情同意书。结果①与nhsPDA组PDA VLBW早产儿比较,hsPDA-lr组及hsPDA-rl/bd组PDA VLBW早产儿出生胎龄均更小,BW均更低,出生胎龄≤28周、24 h内气管插管、肺表面活性剂(PS)使用、血管活性药物使用、布洛芬使用、PDA分流时间≥7 d、BPD、BPD(2~3级)、≥3级颅内出血(IVH)及早产儿视网膜病变(ROP)患儿比例均更高,并且差异均有统计学意义(P<0.05)。②与hsPDA-lr组PDA VLBW早产儿比较,hsPDA-rl/bd组出生胎龄更小,BW更低,出生胎龄≤28周、肺出血、血管活性剂使用患儿比例更高,机械通气时间更长,并且差异均有统计学意义(P<0.05)。③多因素非条件logistic回归分析结果显示,PDA分流时间≥7 d(OR=2.500,95%CI:1.121~5.572,P=0.025;OR=3.395,95%CI:1.195~9.646,P=0.022)为PDA VLBW早产儿发生BPD及BPD(2~3级)的独立危险因素。结论VLBW早产儿的BPD及BPD(2~3级)发病风险,在PDA分流时间≥7 d后升高。对PDA VLBW早产儿进行早期精细化管理,对其发生BPD的风险评估及防治,具有重要临床意义。

Objective To investigate the correlation between the shunt direction and duration of patent ductus arteriosus(PDA)and bronchopulmonary dysplasia(BPD)in preterm infants with very low birth weight(VLBW).Methods From January 2020 to June 2023,a total of 193 PDA VLBW preterm infants with birth gestational age<32 weeks and birth weight(BW)<1500 g who were hospitalized in the Affiliated Hospital of Xuzhou Medical University,were enrolled into this study.Using retrospective analysis method,they were divided into 3 groups based on the echocardiographic results after 7 d of birth:the nhsPDA(non-hemodynamically significant PDA)group(n=89),the hsPDA-lr(hemodynamically significant PDA left to right shunt)group(n=65)and the hsPDA-rl/bd(hemodynamically significant PDA right to left/bidirectional shunt)group(n=39).The general clinical data,complication incidence rates and therapeutic effect among 3 groups of PDA VLBW preterm infants were statistically compared.Independent risk factors affecting the development of BPD and BPD(grades 2-3)in these PDA VLBW preterm infants were analyzed by single-factor and multivariate unconditional logistic regression analysis.The study was approved by the Ethics Committee of the Affiliated Hospital of Xuzhou Medical University(Approval No.XYFY2022-KL302-01),and informed consents were obtained from all guardians of premature infants.Results①Compared to PDA VLBW preterm infants in nhsPDA group,PDA VLBW preterm infants in hsPDA-lr group and hsPDA-rl/bd group were all younger in birth gestational age,had lower BW,had higher proportions of infants with birth gestational age≤28 weeks,tracheal intubation within 24 h,use of pulmonary surfactant(PS),use of vasoactive drugs,use of ibuprofen,PDA shunt duration≥7 d,BPD,BPD(grades 2-3),intracranial hemorrhage(IVH)(≥grade 3)and retinopathy of premature(ROP),all differences were statistically significant(P<0.05).②Compared to PDA VLBW preterm infants in hsPDA-lr group,infants in hsPDA-rl/bd group had younger birth gestational age,lower BW,had higher proportions of infants with birth gestational age≤28 weeks,pulmonary haemorrhage,use of vasoactive drugs,and longer duration of mechanical ventilation,and all differences were statistically significant(P<0.05).③Multivariate unconditional logistic regression analysis showed that PDA shunt duration≥7 d(OR=2.500,95%CI:1.121-5.572,P=0.025;OR=3.395,95%CI:1.195-9.646,P=0.022)were independent risk factors for the development of BPD and BPD(grades 2-3)of PDA VLBW preterm infants.Conclusions The risk of developing BPD and BPD(grades 2-3)in VLBW preterm infants was increased after PDA shunt duration≥7 d.Early refined management of PDA VLBW preterm infants is clinically significant to evaluate the risk and for the prevention and treatment of BPD.