产前糖皮质激素使用情况对<34周早产儿预后的影响

Effect of Antenatal Corticosteroids Use on Prognosis of Preterm Infants < 34 Weeks

摘要: 目的：探讨<34周早产儿产前糖皮质激素使用情况对其预后的影响，为临床规范使用产前糖皮质激素提供参考依据。方法：收集2019年1月~2020年6月在青岛妇女儿童医院产科出生收入本院NICU胎龄 < 34周的早产儿的临床资料。所有病例产前使用的糖皮质激素均为地塞米松，根据其使用情况，分为未使用组，使用1~2次组，使用3~4次组。通过检验或秩和检验对比较产前糖皮质激素使用情况对其并发症发生率的影响。结果：研究期间共纳入261例，未使用组共43例(16.48%)，使用1~2次组共66例(25.29%)，使用3~4次组共152例(58.24%)，糖皮质激素使用率83.52%。早产儿一般情况中，使用3~4次组患儿剖宫产发生率和5 min Apgar评分均低于未使用组(P < 0.0167)，在并发症方面，使用组NRDS发生率低于未使用组，并且ACS的使用次数越多，NRDS发生率越低，差异有统计学意义(P < 0.0167)。使用组有创通气 ≥ 7 d的发生率低于未使用组，最高吸入氧浓度也随使用次数增加，逐渐降低。使用3~4次组患儿PDA发生率低于使用1~2次组，使用3~4次组患儿PVL发生率低于未使用组，使用3~4次组患儿纠正6月龄时MDI高于未使用组(P值均 < 0.0167)。结论：产前糖皮质激素在一定程度上能改善早产儿的预后，并且这种改善程度与产前糖皮质激素使用次数有关。

Abstract: Objective: To explore the effect of antenatal corticosteroids use in preterm infants < 34 weeks on its prognosis, and to provide a reference for the clinical standard use of prenatal glucocorticoids. Methods: The clinical data of premature infants whose NICU gestational age is less than 34 weeks in Qingdao Women and Children’s Hospital from January 2019 to June 2020 were collected. The corticosteroids used before delivery in all cases was dexamethasone. According to its use, they were divided into non-use group, 1 - 2 times group, and 3 - 4 times group. The incidences of complications were compared between different groups using Chi-square test or rank sum test. Results: A total of 261 cases were enrolled .There were 43 cases (16.48%) in the non-use group, 66 cases (25.29%) in the 1 - 2 times group, and 152 cases (58.24%) in the 3 - 4 times group. The glucocorticoid use rate was 83.52%. In the general situation of preterm infants, the incidence of cesarean section and 5 min Apgar score of children in the 3 - 4 times group were lower than those in the non-use group (P < 0.0167). In terms of complications, the incidence of NRDS in the ACS group was lower than that in the non-use group. In addition, the incidence of invasive ventilation greater than or equal to 7 days in the ACS use group was lower than that in the non-use group, and the maximum inhaled oxygen concentration also increased with the use of ACS, and gradually decreased. The incidence of PDA in the 3 - 4 times of use group was lower than that in the 1~2 times of use group, the incidence of PVL in the 3 - 4 times of use group was lower than that in the no-use group, and MDI corrected at 6 months of age in the 3 - 4 times of use group was higher than that in the no-use group (P < 0.0167). Conclusions: Antenatal corticosteroids can improve the prognosis of preterm infants to a certain extent, and the degree of improvement is related to the frequency of antenatal corticosteroids use.