胎龄<34周呼吸窘迫综合征早产儿发生支气管肺发育不良危险因素分析

Analysis of Risk Factors of Bronchopulmonary Dysplasia in Premature Infants with Respiratory Distress Syndrome at <34 Weeks

摘要: 目的：探讨<34周呼吸窘迫综合征(RDS)早产儿发生支气管肺发育不良(BPD)的危险因素。方法：回顾性分析166例<34周RDS早产儿的临床资料及实验室检查结果，根据是否发生支气管肺发育不良(BPD)，分为BPD组和非BPD组，比较两组早产儿一般情况、呼吸干预及孕母情况，通过Logistic回归模型分析影响RDS发生BPD的高危因素。结果：在166例早产儿中，BPD共95例(57.22%)，非BPD共71例。两组在胎龄、生产方式、出生体重，使用肺表面活性物质(PS)、使用咖啡因、机械通气时间、最高吸入FiO2、无创通气时间、总呼吸支持时间、PDA干预、新生儿肺炎、败血症、肺出血、贫血、组织学绒毛膜羊膜炎(HCA)、产前使用地塞米松的差异有统计学意义(P < 0.05)，而性别、宫内窘迫、窒息、孕母年龄、胎膜早破、妊娠期糖尿病的差异无统计学意义(P > 0.05)。多因素Logistic回归分析，显示胎龄、出生体重、产前使用地塞米松是RDS早产儿发生BPD的保护性因素，而机械通气时间是其独立危险因素。结论：对于<34周RDS早产儿临床上适当延长孕周增加胎儿体重、积极规范使用产前地塞米松、减少机械通气时间，是预防RDS发生BPD的重要措施。

Abstract: Objective: To explore risk factors of bronchopulmonary dysplasia in premature infants with respiratory distress syndrome at <34 weeks. Methods: The clinical data and laboratory examination results of 166 premature infants with RDS at <34 weeks were retrospectively analyzed. The premature infants were divided into BPD group and non-BPD group according to the presence of bronchopulmonary dysplasia (BPD). The general conditions, respiratory intervention and maternal status of the two groups of premature infants were compared, the risk factors for the development of BPD in premature infants with RDS were identified by multiple logistic regression analysis. Results: Among the 166 preterm infants, there were 95 cases (57.22%) of BPD and 71 cases of non-BPD. In the two groups, gestational age, production method, birth weight, use of pulmonary surfactant (PS), use of caffeine, mechanical ventilation time, maximum inhaled FiO2, non-invasive ventilation time, total respiratory support time, PDA intervention, neonatal pneumonia, sepsis, pulmonary hemorrhage, anemia, histological chorioamnionitis (HCA), and prenatal use of dexamethasone were statistically significant (P < 0.05), while there was no statistically significant difference in gender, intrauterine distress, asphyxia, maternal age, premature membranes, diabetes and gestational diabetes (P > 0.05). Multiple Logistic regression analysis showed that gestational age, birth weight and prenatal use of dexamethasone were protective factors for BPD in RDS premature infants, while mechanical ventilation duration was an independent risk factor. Conclusions: For preterm infants with RDS at <34 weeks, appropriate extension of gestational week to increase of fetal weight, active and standardized use of prenatal dexamethasone, and reduction of mechanical ventilation time are important measures to prevent the occurrence of BPD in RDS.