胎龄 < 32周早产儿支气管肺发育不良临床危险因素及并发症的分析与防治策略

Analysis ofClinical Risk Factors, Complications and Prevention Strategies for Bronchopulmonary Dysplasia in Preterm Infants with Gestational Age < 32 Weeks

摘要: 目的：探讨胎龄 < 32周早产儿支气管肺发育不良(bronchopulmonary dysplasia, BPD)的临床危险因素，探寻早产儿发生BPD的防治策略以及综合管理措施。方法：回顾性调查2016年1月至2018年10月期间于青岛大学附属医院新生儿重症监护室(NICU)住院的胎龄 < 32周532例早产儿的临床资料，按BPD的诊断标准分为BPD组(病例组，共134例)和非BPD组(对照组，共398例)，对两组临床资料进行对比分析。结果：本研究BPD发生率为25.2%，其发生与IVF-ET、顺产、胎膜早破 > 18 h、羊水污染、胎龄、出生体重、1分钟Apgar评分、5分钟Apgar评分、单剂PS应用、多剂PS应用、侵入性有创机械通气时间、无创通气时间、面罩/鼻导管吸氧时间、吸入氧浓度 ≥ 30%、输血和输血次数等因素相关(P均<0.05)；BPD与新生儿肺炎、败血症、NRDS、PDA、早产儿脑损伤、ROP、代谢性骨病、胆汁淤积、肺动脉高压等疾病有统计学关联(P均<0.05)。结论：避免早产、减少孕母产前感染及早产儿生后感染、缩短机械通气和用氧时间、降低用氧浓度和积极防治并发症，以期预防BPD的发生并改善预后。

Abstract: Objective: To explore the clinical risk factors of bronchopulmonary dysplasia in preterm infants with gestational age < 32 weeks, and to seek the strategies and comprehensive management measures for prevening or treating BPD. Methods: Retrospective investigation of clinical data of 532 preterm infants with gestational age of <32 weeks who were admitted to the neonatal intensive care unit (NICU) of the Affiliated Hospital of Qingdao University from June 2016 to October 2018. They were divided into BPD groups according to the diagnostic criteria of BPD (case Group, total 134 patients) and non-BPD group (control group, total 398 patients), then, compared and analyzed the clinical risk factors of the two groups. Results: The incidence of BPD in this study was 25.2%. And the IVF-ET, normal labor, premature rupture of membranes > 18 h, amniotic fluid pollution, gestational age, birth weight, 1-minute Apgar score, 5-minute Apgar score, single-dose PS application, multiple-dose PS application, invasive mechanical ventilation time, non-invasive ventilation Time, mask/nasal catheter oxygen inhalation time, inhaled oxygen concentration ≥ 40%, blood transfusion and blood transfusion times and other factors were the related risk factors of BPD (all P < 0.05). BPD was statistically associated with neonatal pneumonia, sepsis, NRDS, PDA, brain injury in preterm infants, ROP, metabolic bone disease, cholestasis, pulmonary hypertension (all P < 0.05). Conclusion: In order to prevent preterm infants with gestational age < 32 weeks frome BPD and improve the prognosis, we need to avoid preterm birth, reduce pregnant women prenatal infections and preterm infants infections, shorten mechanical ventilation and use oxygen time, reduce oxygen concentration and actively prevent and treat complications.