超/极早产儿肺支气管发育不良的危险因素分析

Analysis of Risk Factors for Pulmonary Bronchial Dysplasia in Ultra/Extremely Premature Infants

摘要: 目的：分析超/极早产儿发生BPD的影响因素，旨在为防治BPD的发生提供诊疗建议。方法：选取了215例从2018年1月至2022年12月之间在延安大学附属医院新生儿科住院的超/极早产儿(胎龄小于32周的早产儿)，根据患儿生后28天是否仍然不能脱离氧气，分为BPD组(N = 59)和非BPD组(N = 156)。对两组患儿及其母亲孕期的临床资料进行回顾性分析，具有统计学意义的指标进一步纳入多因素logistic回归分析超早/极早产儿发生BPD的危险因素。结果：患儿胎龄越小，出生体重越低，发生BPD的几率就越高。多因素logistic回归分析显示：患儿合并贫血(OR = 4.882, 95% CI: 1.088~21.899)、生后使用无创辅助通气的时间(OR = 1.206, 95% CI: 1.029~1.412)、吸入氧浓度 > 40%的时间(OR = 1.464, 95% CI: 1.202~1.783)、输注红细胞次数(OR = 4.940, 95% CI: 2.210~11.042)及母亲孕期患有绒毛膜羊膜炎(OR = 6.772, 95% CI: 1.501~30.563)是超/极早产儿发生BPD的独立危险因素。患儿的胎龄(OR = 0.425, 95% CI: 0.236~0.765)是超/极早产儿发生BPD的保护因素。结论：加强母亲孕期的保健工作以降低发生早产的可能性，以及早产儿生后采用肺保护性通气策略，尽量减少吸入高浓度氧气的时间，谨慎输血等措施非常重要，均会对预防BPD的发生和提高早产儿的预后有很大的帮助。

Abstract: Objective: The objective of this study was to analyze the factors that influence the development of Bronchopulmonary dysplasia (BPD) in ultra/very preterm infants. Methods: A total of 215 ultra/ extremely preterm infants (i.e., infants with a gestational age less than 32 weeks) admitted to the Department of Neonatology of the Affiliated Hospital of Yan’an University between January 2018 and December 2022 were included in this study. These infants were divided into two groups: the BPD group (n = 59) and the non-BPD group (n = 156), based on whether they still required oxygen support at 28 days after birth. We carried out a retrospective survey to gather clinical data on the infants and their mothers throughout the pregnancy. The study analyzed the disparities in infant characteristics and maternal conditions between the two groups. Additionally, multivariate logistic regression was employed to determine the significant factors associated with the risk of bron-chopulmonary dysplasia (BPD) in preterm infants. The findings indicated that preterm infants with a younger gestational age, lower body weight, and higher incidence of BPD were more likely to ex-perience this condition. The multivariate logistic regression analysis demonstrated that maternal chorioamnionitis significantly enhanced the likelihood of developing BPD in preterm infants (OR = 6.772, 95% CI: 1.501~30.563). In addition, anemia in preterm infants (OR = 4.882, 95% CI: 1.088~21.899), prolonged use of non-invasive ventilation (OR = 1.206, 95% CI: 1.029~1.412), a greater percentage of time with FiO2 levels above 40% (OR = 1.464, 95% CI: 1.202~1.783), and a higher number of red blood cell transfusions (OR = 4.940, 95% CI: 2.210~11.042) were also identi-fied as independent risk factors for BPD in ultra/very preterm infants. On the other hand, it was discovered that the gestational age acted as a safeguard against BPD (OR = 0.425, 95% CI: 0.236~ 0.765). In conclusion, providing comprehensive antenatal care and conducting regular prenatal examinations can help prevent the occurrence of BPD and improve the prognosis of preterm in-fants. Additionally, minimizing the need for oxygen support in newborns, adopting lung-protective ventilation strategies, avoiding high concentrations of inhaled oxygen, and being cautious with blood transfusions are all crucial steps to be taken.