2015-2018年早产儿支气管肺发育不良的发病情况和相关因素分析

doi:10.11852/zgetbjzz2018-1854

摘要/Abstract

摘要： 目的了解早产儿支气管肺发育不良(BPD)发病情况,分析BPD发病相关因素,为临床防治BPD提供依据。方法纳入2015年1月－2018年6月新疆维吾尔自治区人民医院出生的1 426例早产儿为研究对象,根据有无BPD分为BPD组和对照组,比较两组产妇及新生儿临床资料,行单因素分析、多因素Logistic回归分析研究BPD发病危险因素。结果 1 426例早产儿中,BPD患儿88例(6.17%),其中轻度23例(26.14%)、中度49例(55.68%)、重度16例(18.18%);单因素分析显示,产妇年龄、妊娠高血压、长期二手烟接触、过度劳累、宫内感染、羊膜炎及新生儿胎龄、出生体重、1 min Apgar评分、新生儿急性呼吸窘迫综合征(NRDS)、肺出血、颅内出血、视网膜病变、贫血、机械通气、肺表面活性物质(PS)使用、用氧时间、最高给氧浓度>40%均与早产儿BPD发病相关(P<0.05);多因素Logistic回归分析显示,产妇宫内感染(OR=3.300,95%CI:1.367~7.967)及新生儿胎龄<28周(OR=4.162,95%CI:2.379~7.281)、出生体重<1 500 g(OR=4.591,95%CI: 2.926~7.202)、肺出血(OR=2.654,95%CI: 1.329~5.300)、贫血(OR=5.836,95%CI: 2.129~15.993)、机械通气(OR=4.033,95%CI: 1.953~8.175)是早产儿BPD发病危险因素(P<0.05)。结论早产儿BPD发病与产妇宫内感染、早产儿胎龄、出生体重及有无肺出血、贫血、机械通气有关,临床应根据产妇、新生儿情况制定相关防治措施,以减少BPD发生,改善早产儿生存率及生存质量。

关键词: 早产儿, 支气管肺发育不良, 危险因素

Abstract: Objective To understand the prevalence of bronchopulmonary dysplasia(BPD) in premature infants,and to analyze the relevant factors for BPD,in order to provide evidence for clinical prevention and treatment. Methods A total of 1 426 premature infants born in Xinjiang Uygur Autonomous Region People′s Hospital were enrolled in the study from January 2015 to June 2018,and were divide into BPD group and control group.The clinical data of puerperae and neonates were compared between the two groups.And univariate analysis and multivariate Logistic regression analysis were used to find out the risk factors of BPD. Results Among 1 426 premature infants,88(6.17%) cases suffered from BPD,including 23(26.14%) mild cases,49(55.68%) moderate cases and 16(18.18%) severe cases.Univariate analysis showed that maternal age,gestational hypertension,long-term smoking or second-hand smoking,overwork,intrauterine infection,amnionitis,and neonatal gestational age,birth body weiyht,1 min Apgar score,neonatal acute respiratory distress syndrome(NRDS),pneumorrhagia,intracranial hemorrhage,retinopathy,anemia,mechanical ventilation,pulmonary surfactant(PS) use,oxygen use time and maximum oxygen concentration>40% were associated with the BPD in premature infants(P<0.05).Multivariate Logistic regression analysis showed that intrauterine infection of puerperae(OR=3.300,95%CI:1.367-7.967),and gestational age ≤28 weeks(OR=4.162,95%CI:2.379-7.281),birth body weight<1 500 g(OR=4.591,95%CI: 2.926-7.202),pneumorrhagia(OR=2.654,95%CI: 1.329-5.300),anemia(OR=5.836,95%CI: 2.129-15.993),and mechanical ventilation(OR=4.033,95%CI: 1.953-8.175) were risk factors for BPD in premature infants(P<0.05). Conclusions BPD in premature infants is related to intrauterine infection,preterm gestational age,birth body weight,presence or absence of pneumorrhagia,anemia and mechanical ventilation.Clinical prevention and treatment measures are supposed to be made according to maternal and neonatal conditions so as to reduce the incidence of BPD and to improve the survival rate and quality of life of premature infants.

Key words: premature infants, bronchopulmonary dysplasia, risk factors

中图分类号:

R722.6

杨蛟, 努尔亚·热加甫, 刘永巧. 2015-2018年早产儿支气管肺发育不良的发病情况和相关因素分析[J]. 中国儿童保健杂志, 2019, 27(10): 1102-1104.

YANG Jiao, Nouery·ejiapu, LIU Yong-qiao. Analysis of prevalence and related factors of bronchopulmonary dysplasia in premature infants in a hospital from 2015 to 2018[J]. journal1, 2019, 27(10): 1102-1104.

参考文献

[1] 伊丽丽.早产儿支气管肺发育不良的发病机制及治疗现状[J].国际儿科学杂志,2018,45(3):212-215.
[2] 陈奕江,张水堂,杨润娜.生后7天内气道内应用布地奈德对早产儿支气管肺发育不良发生率影响的系统评价和Meta分析[J].中国循证儿科杂志,2016,11(4):259-264.
[3] 茹喜芳,王颖,谢生勇,等.早产儿支气管肺发育不良发病及随访情况分析[J].中华实用儿科临床杂志,2017,32(2):100-104.
[4] 常立文.早产儿支气管肺发育不良的定义演变及其诊断[J].中国实用儿科杂志,2014,29(1):1-4.
[5] 梁穗新,王一飞,何少茹.早产儿生理性支气管肺发育不良研究进展[J].中华实用儿科临床杂志,2016,31(2):158-160.
[6] Phillp AG.Bronchopulmonary dysplasia:then and now.[J].Neonatology,2012,102(1):1-8.
[7] 早产儿支气管肺发育不良调查协作组.早产儿支气管肺发育不良发生率及高危因素的多中心回顾调查分析[J].中华儿科杂志,2011,49(9):655-662.
[8] 张明霞,赵瑞卿,李庆霞,等.早产儿支气管肺发育不良的影响因素分析[J].蚌埠医学院学报,2017,42(10):1321-1323.
[9] 杨俏文.200例早产儿支气管肺发育不良的临床研究[J].中国妇幼保健,2016,31(8):1662-1664.
[10] 钱颖,陈尊,王有成,等.早产儿支气管肺发育不良的高危因素分析[J].中国妇幼保健,2018,33(3):572-574.
[11] Pan J,Zhan C,Yuan T,et al.Effects and molecular mechanisms of intrauterine infection/inflammation on lung development[J].Resp Res,2018,19(1):93.
[12] 赵海燕,陈红武.宫内感染与早产儿支气管肺发育不良[J].中国儿童保健杂志,2012,20(3):241-243.
[13] Silva LV,de Araújo LB,Silva LV,et al.Assessment of the neuropsychomotor development in the first year of life of premature infants with and without bronchopulmonary dysplasia[J].Revista Brasileira De Terapia Intensiva,2018,30(2):174-180.
[14] Balena-Borneman J,Ambalavanan N,Tiwari HK,et al.Biomarkers associated with bronchopulmonary dysplasia/mortality in premature infants[J].Pediatr Res,2016:81(3):519-525.
[15] 岳伟红.早产儿支气管肺发育不良临床高危因素分析[J].儿科药学杂志,2016,22(4):16-19.
[16] 王玉光,刘冬云,姜红,等.早产儿中重度支气管肺发育不良临床高危因素分析[J].中国综合临床,2017,33(6):511-514.
[17] 张妮.早产儿支气管肺发育不良的防治[J].国际儿科学杂志,2017,44(1):1-5.
[18] 尹燕丹,祁媛媛,洪达,等.早产儿支气管肺发育不良危险因素及2岁时随访结局[J].中国循证儿科杂志,2016,11(2):113-117.