支气管肺发育不良早产儿44例临床分析

摘要

目的 分析支气管肺发育不良(BPD)早产儿的临床特点及高危因素,探讨BPD的防治措施.方法 回顾性分析2009年1月至2012年12月本院NICU收治的极低出生体重早产儿临床资料,最终诊断BPD的早产儿为BPD组,同期未患BPD的早产儿为对照组,比较两组患儿围产期病史、临床表现、治疗、并发症及新生儿期结局.结果 研究期间共收治极低出生体重早产儿227例,159例在本院救治并存活至28天,纳入研究,其中44例早产儿诊断BPD(27.7％),轻度36例(81.8％).单因素分析显示,与对照组比较,BPD组患儿出生胎龄小,出生体重低,男性、宫内感染、新生儿呼吸窘迫综合征(RDS)、动脉导管未闭(PDA)、医院感染比率高,接受辅助通气时间长,差异有统计学意义(P＜0.05);两组以病理学为依据的绒毛膜羊膜炎及胎儿炎症差异无统计学意义(P＞0.05).将出生胎龄＜32周、出生胎龄＜30周、出生体重＜1 000 g、使用呼吸机、RDS及分期、PDA、肺炎、宫内感染、母亲胎盘绒毛膜羊膜炎、医院感染、性别与BPD发生的关系作多因素Logistic回归分析,发现出生胎龄＜30周(OR9.629,95％ CI 2.767～33.513)及男性(OR3.047,95％ CI l.037～8.948)是BPD发生的高危因素.结论 避免早产、合理通气策略、预防和控制感染可能减少BPD发生,远期随访更重要.%Objective To study clinical features and risk factors of preterm infants with bronchopulmonary dysplasia (BPD) and develop prevention methods.Methods Very low birth weight (VLBW) infants admitted to the neonatal intensive care unit (NICU) of our hospital from January 2009 to December 2012 were recruited and their clinical data reviewed retrospectively.The preterm infants with BPD were assigned into the observation group, the others the control group.Perinatal history, clinical manifestation, treatments, complications and prognosis in the neonatal period were compared between the two groups.Results A total of 227 VLBW infants were recruited.159 infants who lived more than 28 days were enrolled into this study.44 preterm infants were diagnosed with BPD (27.7％, 44/159), and 36 cases were mild type.Univariate analysis showed that lower birth weight, smaller gestational age and longer duration of mechanical ventilation were associated with BPD diagnosis (P ＜ 0.05).Male infants, respiratory distress syndrome (RDS), patent ductus arteriosus (PDA), intrauterine infection and nosocomial infection were higher in the BPD group (P ＜ 0.05).As for incidence of chorioamnionitis and fetal infection, no statistically significant differences existed between the two groups (P ＞ 0.05).Multivariate analysis showed that risk factors for BPD were gestational age ＜30 w (OR 9.629,95％ C1 2.767-33.513) and male gender (OR 3.047,95％ CI 1.037-8.948).Conclusions Avoiding premature birth, proper ventilation strategy and prevention of infection may reduce the incidence of BPD.Follow-up of BPD infants is also very important.