目的 分析合并新生儿呼吸窘迫综合征(NRDS)的胎龄＜32周的极低出生体重儿发生支气管肺发育不良(BPD)的危险因素,为临床诊治提供参考依据。方法 选取2019年10月—2020年7月郑州大学第三附属医院新生儿重症监护室收治的合并呼吸窘迫综合征、胎龄＜32周、出生体重＜1 500 g的早产儿138例,根据是否发生BPD,分为BPD组(32例)和非BPD组(106例)。收集所有早产儿的出生与治疗情况、母亲孕期情况,并进行分析。结果 单因素分析显示,BPD组与非BPD组胎龄、出生体重、机械通气应用率、生后糖皮质激素应用率、新生儿感染发生率、产前感染发生率比较,差异有统计学意义(t=3.444、2.912,χ2=24.089、5.208、8.586、9.486,P＜0.05);多因素Logistic回归分析显示:胎龄≥28周是BPD的保护因素(28～周OR=0.143,95%CI:0.035～0.579;30～＜32周OR=0.210,95%CI:0.047～0.939),机械通气(OR=5.459,95%CI:1.991～14.963)、新生儿感染(OR=4.075,95%CI:1.031～16.106)、产前感染(OR=3.375,95%CI:1.051～10.833)是BPD发生的独立危险因素。结论 预防感染、避免早产、减少机械通气是减少合并NRDS、胎龄＜32周、出生体重＜1 500g的早产儿发生BPD的重要措施。
Abstract
Objective To analyze the risk factors of bronchopulmonary dysplasia (BPD) in very low birth weight infants with neonatal respiratory distress syndrome (NRDS) and gestational age < 32 weeks,in order to provide reference for the prevention of BPD. Methods A total of 138 cases of preterm infants diagnosed with NRDS,with gestational age < 32 weeks and birth weight < 1 500 g,were enrolled into this study from October 2019 to July 2020 in the Neonatal Intensive Care Unit of the Third Affiliated Hospital of Zhengzhou University,and were divided into BPD group (n=32) and non-BPD group (n=106). Data on birth,treatment and pregnancy were collected and analyzed to determine the risk factors of BPD in these infants. Results Single factors analysis showed that there were significant differences in gestational age,birth weight,mechanical ventilation,glucocorticoids usage after birth,incidence rates of neonatal infection and prenatal infection between BPD group and non-BPD group (t=3.444,2.912,χ2=24.089,5.208,8.586,9.486,P＜0.05). Multivariate Logistic regression showed that gestational age ≥28 weeks was a protective factor for BPD(28—＜30 weeks OR=0.143,95%CI:0.035—0.579;30—＜32 weeks:OR=0.210,95%CI:0.047—0.939),while mechanical ventilation (OR=5.459,95%CI:1.991—14.963),neonatal infection (OR=4.075,95%CI:1.031—16.106) and prenatal infection(OR=3.375,95%CI:1.051—10.833)were independent risk factors of BPD (P<0.05). Conclusion Preventing infection,avoiding preterm delivery and reducing mechanical ventilation are important measures to reduce BPD in preterm infants diagnosed with NRDS,with gestational age < 32 weeks and birth weight < 1 500 g.
关键词
新生儿呼吸窘迫综合征 /
支气管肺发育不良 /
早产儿
Key words
neonatal respiratory distress syndrome /
bronchopulmonary dysplasia /
preterm infants
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