中华实用儿科临床杂志
中華實用兒科臨床雜誌
중화실용인과림상잡지
Journal of Applied Clinical Pediatrics
2015年
10期
757-760
,共4页
任艳丽%孔祥永%杜志方%封志纯
任豔麗%孔祥永%杜誌方%封誌純
임염려%공상영%두지방%봉지순
支气管肺发育不良%危险因素%婴儿,新生%前瞻性研究
支氣管肺髮育不良%危險因素%嬰兒,新生%前瞻性研究
지기관폐발육불량%위험인소%영인,신생%전첨성연구
Bronchopulmonary dysplasia%Risk factor%Infant,newborn%Prospective study
目的 探析早产儿支气管肺发育不良(BPD)的危险因素.方法 应用前瞻性队列研究的方法,对2013年11月至2014年5月入住南方医科大学北京军区总医院临床医学院附属八一儿童医院新生儿科极早产病房胎龄＜32周,出生24 h内入院且存活至出生28 d以上的早产儿进行研究.按是否确诊BPD分为2组(BPD组、非BPD组),比较2组间孕母情况、新生儿基本情况及疾病和治疗情况的差异.采用t检验、x2检验、Fisher's确切概率法及Logistic回归模型分析早产儿BPD的危险因素.结果 1.共纳入对象298例.其中男180例,女118例;胎龄25.6 ～31.9(29.9±1.4)周;出生体质量740～2 300(1 428.3±289.0)g,超低出生体质量儿19例,极低出生体质量儿175例.确诊BPD 69例(轻度43例,中度10例,重度16例),BPD发生率为23.2％.2.BPD的发生与胎龄及出生体质量呈负相关:＜28周、28～ 30周、≥30～32周BPD发病率分别为70.4％、41.9％和6.2％;出生体质量＜1 000 g、1 000～1 500 g、≥1 500～1 800 gBPD发病率分别为78.9％、29.5％和8.8％.3.多因素Logistic逐步回归得出胎龄(OR=4.52)、出生体质量(OR =3.38)、性别(OR=3.04)、巨细胞病毒感染(OR=55.27)、气管插管通气天数≥7 d(OR=3.22)、最高吸入氧体积分数≥400 mL/L(OR =4.14)、手术治疗动脉导管未闭(PDA)(OR =7.30)、出生14 d内输注红细胞(OR=3.51)为独立危险因素(P均＜0.05).4.出生体质量(P=0.015)、气管插管通气时间(P=0.003)、吸氧时间(P=0.000)、是否手术治疗关闭PDA(P=0.017)与BPD发生的严重程度有关.结论 早产儿BPD为多因素疾病,针对危险因素采取有效的干预措施是预防BPD的关键.
目的 探析早產兒支氣管肺髮育不良(BPD)的危險因素.方法 應用前瞻性隊列研究的方法,對2013年11月至2014年5月入住南方醫科大學北京軍區總醫院臨床醫學院附屬八一兒童醫院新生兒科極早產病房胎齡＜32週,齣生24 h內入院且存活至齣生28 d以上的早產兒進行研究.按是否確診BPD分為2組(BPD組、非BPD組),比較2組間孕母情況、新生兒基本情況及疾病和治療情況的差異.採用t檢驗、x2檢驗、Fisher's確切概率法及Logistic迴歸模型分析早產兒BPD的危險因素.結果 1.共納入對象298例.其中男180例,女118例;胎齡25.6 ～31.9(29.9±1.4)週;齣生體質量740～2 300(1 428.3±289.0)g,超低齣生體質量兒19例,極低齣生體質量兒175例.確診BPD 69例(輕度43例,中度10例,重度16例),BPD髮生率為23.2％.2.BPD的髮生與胎齡及齣生體質量呈負相關:＜28週、28～ 30週、≥30～32週BPD髮病率分彆為70.4％、41.9％和6.2％;齣生體質量＜1 000 g、1 000～1 500 g、≥1 500～1 800 gBPD髮病率分彆為78.9％、29.5％和8.8％.3.多因素Logistic逐步迴歸得齣胎齡(OR=4.52)、齣生體質量(OR =3.38)、性彆(OR=3.04)、巨細胞病毒感染(OR=55.27)、氣管插管通氣天數≥7 d(OR=3.22)、最高吸入氧體積分數≥400 mL/L(OR =4.14)、手術治療動脈導管未閉(PDA)(OR =7.30)、齣生14 d內輸註紅細胞(OR=3.51)為獨立危險因素(P均＜0.05).4.齣生體質量(P=0.015)、氣管插管通氣時間(P=0.003)、吸氧時間(P=0.000)、是否手術治療關閉PDA(P=0.017)與BPD髮生的嚴重程度有關.結論 早產兒BPD為多因素疾病,針對危險因素採取有效的榦預措施是預防BPD的關鍵.
목적 탐석조산인지기관폐발육불량(BPD)적위험인소.방법 응용전첨성대렬연구적방법,대2013년11월지2014년5월입주남방의과대학북경군구총의원림상의학원부속팔일인동의원신생인과겁조산병방태령＜32주,출생24 h내입원차존활지출생28 d이상적조산인진행연구.안시부학진BPD분위2조(BPD조、비BPD조),비교2조간잉모정황、신생인기본정황급질병화치료정황적차이.채용t검험、x2검험、Fisher's학절개솔법급Logistic회귀모형분석조산인BPD적위험인소.결과 1.공납입대상298례.기중남180례,녀118례;태령25.6 ～31.9(29.9±1.4)주;출생체질량740～2 300(1 428.3±289.0)g,초저출생체질량인19례,겁저출생체질량인175례.학진BPD 69례(경도43례,중도10례,중도16례),BPD발생솔위23.2％.2.BPD적발생여태령급출생체질량정부상관:＜28주、28～ 30주、≥30～32주BPD발병솔분별위70.4％、41.9％화6.2％;출생체질량＜1 000 g、1 000～1 500 g、≥1 500～1 800 gBPD발병솔분별위78.9％、29.5％화8.8％.3.다인소Logistic축보회귀득출태령(OR=4.52)、출생체질량(OR =3.38)、성별(OR=3.04)、거세포병독감염(OR=55.27)、기관삽관통기천수≥7 d(OR=3.22)、최고흡입양체적분수≥400 mL/L(OR =4.14)、수술치료동맥도관미폐(PDA)(OR =7.30)、출생14 d내수주홍세포(OR=3.51)위독립위험인소(P균＜0.05).4.출생체질량(P=0.015)、기관삽관통기시간(P=0.003)、흡양시간(P=0.000)、시부수술치료관폐PDA(P=0.017)여BPD발생적엄중정도유관.결론 조산인BPD위다인소질병,침대위험인소채취유효적간예조시시예방BPD적관건.
Obgective To explore the risk factors of preterm infants with bronchopulmonary dysplasia(BPD).Methods A prospective cohort study was conducted to analyze the risk factors of preterm infants with BPD.Preterm infants (gestational age ＜ 32 weeks,and admission within 24 h since birth,and survival time more than 28 d since birth) who were sent to the Ward of Extremely Preterm Infants in Bayi Children's Hospital Affiliated to Clinical Medical College in Beijing Military General Hospital of Southern Medical University were enrolled from November 2013 to May 2014.According to the diagnostic criteria of BPD,the subjects were divided into 2 groups(BPD group and non-BPD group).Factors such as maternal information,neonatal basic information,neonatal diseases and treatments were compared between the 2 groups.Risk factors of preterm infants with BPD were analyzed by using t test,Chi-square test,Fisher's exact probability method and Logistic regression analysis.Results (1) A total of 298 cases were enrolled in this study.Among these infants,180 cases were male and 118 cases were female.The gestational age ranged from 25.6 to 31.9 weeks with the average age of (29.9 ± 1.4) weeks and the birth weights ranged from 740 to 2 300 g with the average weight of (1 428.3 ± 289.0) g.There were 19 cases of extremely low birth weight and 175 cases of very low birth weight.Sixty-nine cases of these infants were diagnosed as BPD (43 cases were mild,10 cases were moderate,16 cases were severe) with incidence of 23.2％.(2)The incidence of BPD was negatively related to gestational age and birth weight:the incidence of BPD in preterm infants with gestational age ＜ 28 weeks,28-30 weeks and ≥ 30-32 weeks were 70.4％,41.9％ and 6.2％;the incidence of BPD in preterm infants with birth weight ＜ 1 000 g,1 000-1 500 g and ≥ 1 500-1 800 g were 78.9％,29.5％ and 8.8％.(3) Multivariate Logistic regression found gestational age (OR =4.52),birth weight (OR =3.38),gender (OR =3.04),cytomegalovirus infection (OR =55.27),duration of invasive ventilation ≥ 7 d (OR =3.22),the highest concentration of inspired oxygen ≥400 mL/L (OR =4.14),patent ductus arteriosus(PDA) in need of surgical ligation (OR =7.30),and transfusion of packed red blood cells within 14 d since birth (OR =3.51) were the independent risk factors of BPD (all P ＜ 0.05).(4) Factors such as birth weight (P =0.015),duration of invasive ventilation (P =0.003),duration of inspired oxygen (P =0.000),and PDA in need of surgical ligation or not(P =0.017) were related to the severity of BPD.Conclusions BPD is a multifactorial disease.Taking effective measures to control risk factors is the key for preventing BPD.
