支气管肺发育不良婴儿期肺炎68例临床分析

Clinical analysis of 68 cases of infantile pneumonia with bronchopulmonary dysplasia

目的探讨不同月龄、不同程度支气管肺发育不良(bronchopulmonary dysplasia,BPD)患儿婴儿期肺炎临床特征及发生呼吸衰竭的影响因素。方法收集2020年1月至2021年12月郑州大学第三附属医院68例BPD患儿婴儿期罹患肺炎再入院的病例资料,进行回顾性分析。结果68例(132例次)再入院BPD患儿中,中度及重度BPD患儿新生儿期因新生儿呼吸窘迫综合征重复使用肺表面活性剂比例更高,住院期间有创或无创机械通气时长、总氧疗时长均高于轻度组;临床表现及体征主要为喘息、咳嗽、湿啰音、哮鸣音,不同月龄分组比较中差异有统计学意义(P<0.05);呼吸道病原菌以革兰阴性杆菌为主,前3位特殊病原菌为肺炎克雷伯杆菌、铜绿假单胞菌、金黄色葡萄球菌,病毒检出以呼吸道合胞病毒为主;再入院中位住院时间13(8~21)d;60.6%(80/132)患儿进展为重症肺炎,28.8%(38/132)合并呼吸衰竭;中度及重度组BPD患儿住院天数较长、重症肺炎的发生率较高,在>6~12月龄组中比较,差异有统计学意义(P<0.05);回归分析显示,中度BPD(OR值2.842,95%CI:1.138~7.100)、重度BPD(OR值3.336,95%CI:1.085~10.259)是发生呼吸衰竭的独立危险因素。结论BPD尤其中度及重度BPD患儿婴儿期肺炎病情重,住院时间长,易进展重症肺炎、呼吸衰竭,患呼吸道感染时应格外关注。

Objective To explore the clinical characteristics of infantile pneumonia in children with different degrees and months of bronchopulmonary dysplasia.Methods Retrospective collection of medical records of 68 cases with bronchopulmonary dysplasia(BPD)who re-entered in infancy at the Third Affiliated Hospital of Zhengzhou University from January 2020 to December 2021.Results Among 68 cases(132 cases)who re-entered BPD were included.Compared with the mild BPD group,the moderate-severe BPD group had a higher proportion of neonates who received repeated use of pulmonary surfactant due to neonatal respiratory distress during the neonatal period,a longer duration of mechanical ventilation(invasive and non-invasive)and a longer total duration of oxygen therapy during hospitalization.The clinical manifestations are mainly wheezing,coughing,coarse wet rales,and wheezing,the differences are statistically significant in the comparison of different months groups(P<0.05).Respiratory pathogens are mainly Gramnegative bacillus,and the top three special pathogens are Klebsiella pneumoniae pneumoniae,Pseudomonas aeruginosa,Staphylococcus aureus;respiratory virus detected mainly respiratory syncytial virus.The average median hospitalization time of re-entered for 13(8-21)days;60.6%of re-entered(80/132)progressed to severe pneumonia,28.8%(38/132)combined with respiratory failure.The children in the moderate/severe group had higher incidence of days,for hospitalization time and severe pneumonia,and the difference is statisically significant in the June-December months group(P<0.05).Further logical regression analysis shows that moderate BPD(OR:2.84295%CI:1.138~7.100)and severe BPD(OR:3.33695%CI:1.085~10.259)are risk factors for respiratory failure.Conclusion BPD,especially moderate/severe BPD premature infants,have serious pneumonia and have been hospitalized time for a long time.It is prone to severe pneumonia and respiratory failure.Special attention should be paid to respiratory infection.