早产小于胎龄儿发生支气管肺发育不良的危险因素及预后分析

Risk factors and prognosis analysis of bronchopulmonary dysplasia in preterm small for gestational age infants

目的探讨早产小于胎龄(SGA)儿发生支气管肺发育不良(BPD)的影响因素及预后。方法选择2019年1月至2021年12月于青岛大学附属医院新生儿重症监护病房(NICU)住院治疗的92例早产(出生胎龄为24~32周)SGA儿为研究对象。采用回顾性队列研究方法,根据矫正胎龄36周时是否诊断为BPD,将其分为BPD组(n=38)和无BPD组(n=54)。对2组早产SGA儿临床资料、住院期内治疗情况及BPD相关并发症发生率等,采用χ^(2)检验、独立样本t检验及Mann-Whitney U检验进行统计学比较;并采用多因素非条件logistic回归分析法,对影响早产SGA儿发生BPD的独立影响因素进行分析。本研究经本院医学伦理委员会批准(审批文号:QYFY WZLL 28257),所有受试儿监护人对诊疗知情同意并签署临床研究知情同意书。结果①BPD组早产SGA儿生后1个月体重、出生身长及头围、生后1 min及5 min Apgar评分均低于、短于、小于无BPD组;有创机械通气、无创机械通气、吸氧及住院时间,以及肺表面活性剂(PS)使用率均长于、高于无BPD组,并且差异均有统计学意义(P<0.01)。②多因素非条件logistic回归分析结果显示,早产SGA儿无创机械通气时间长(OR=1.180,95%CI:1.064~1.308,P=0.002),生后吸氧时间长(OR=1.295,95%CI:1.126~1.488,P<0.001),均为导致早产SGA儿发生BPD的独立危险因素。③BPD组早产SGA儿感染性肺炎、晚发败血症、有血流动力学意义的动脉导管未闭(hsPDA)及早产儿视网膜病变(ROP)发生率,均高于无BPD组,并且差异均有统计学意义(P<0.05)。结论对于早产SGA儿,临床应适宜掌握无创机械通气及吸氧时间,可降低其BPD及相关并发症发生率。

Objective To investigate influencing factors and prognosis of bronchopulmonary dysplasia(BPD)in preterm small for gestational age(SGA)infants.Methods A total of 92 preterm(gestational age of 24-32 weeks)SGA infants who were hospitalized in Neonatal Intensive Care Unit(NICU)of Affiliated Hospital of Qingdao University from January 2019 to December 2021 were selected as study subjects.Using a retrospective cohort study method,they were divided into BPD group(n=38)and BPD-free group(n=54)according to whether BPD was diagnosed at 36 weeks′corrected gestational age or not.The clinical data,treatment and BPD related complications of preterm SGA infants between two groups were statistically compared by chi-square test,independent samples t test and Mann-Whitney U test.Multivariate unconditional logistic regression analysis was used to analyze the independent influencing factors of BPD in preterm SGA infants.This study was approved by the Medical Ethics Committee of our hospital(Approval No.QYFY WZLL 28257),and the guardians of all subjects gave informed consent to diagnosis and treatment and signed an informed consent form for this clinical study.Results①The body weight at 1 month after birth,birth length and head circumference,Apgar score at 1 min and 5 min after birth of preterm SGA infants in BPD group were lower,shorter and smaller than those in BPD-free group,while invasive mechanical ventilation,noninvasive mechanical ventilation,oxygen inhalation and hospitalization time,and the utilization rate of pulmonary surfactant(PS)were longer,higher than those in BPD-free group,and all the differences were statistically significant(P<0.01).②The results of multivariate unconditional logistic regression analysis showed that the long duration of non-invasive mechanical ventilation(OR=1.180,95%CI:1.064-1.308,P=0.002)and the long duration of oxygen inhalation after birth(OR=1.295,95%CI:1.126-1.488,P<0.001)were independent risk factors for BPD in preterm SGA infants.③The incidences of pneumonia,late-onset sepsis,hemodynamically significant patent ductus arteriosus(hsPDA)and retinopathy of prematurity(ROP)in the BPD group were higher than those in the BPD-free group,and the differences were statistically significant(P<0.05).Conclusion For preterm SGA infants,the timing of non-invasive mechanical ventilation and oxygen inhalation should be appropriately controlled to reduce the incidence of BPD and related complications.