支气管肺发育不良早产儿早期肺外合并症的临床分析

目的 通过对支气管肺发育不良(bronchopulmonary dysplasia,BPD)早产儿生后早期脑室周围-脑室内出血(periventricular intraventricular hemorrhage,PVH-IVH)、脑白质损伤、胃肠外营养相关性胆汁淤积综合征(parenteral nutrition associated cholestasis,PNAC)及代谢性骨病发病情况的临床分析,以期对BPD患儿肺外并发症的预防和监测进行指导.方法 回顾性分析2014年9月至2015年12月于中国医科大学附属盛京医院新生儿病房住院并明确诊断BPD的87例早产儿(BPD组),随机选择同期住院非BPD早产儿90例为对照组(非BPD组),分析两组PVH-IVH、脑白质损伤、PNAC及代谢性骨病等肺外并发症的发生率.结果 BPD组早产儿PVH-IVH发病率[26.4%(23/87)]高于非BPD组[11.1%(10/90)] (P＜0.01),其中BPD组Ⅰ~Ⅱ级PVH-IVH发病率也明显升高[24.1%(21/87) 比 11.1%(10/90)](P＜0.05),而Ⅲ~Ⅳ级PVH-IVH发生率两组比较差异无统计学意义(P＞0.05).BPD组早产儿脑白质损伤发生率[33.3%(29/87)]明显高于非BPD组[16.7%(15/90)] (P＜0.05),其中的严重类型脑室周围白质软化的发生率BPD组也明显增高[13.7%(12/87) 比 2.2%(2/90)](P＜0.05).此外,BPD组早产儿PNAC[22.9%(20/87) 比 5.5%(5/90)]、代谢性骨病[17.2%(15/87) 比 3.3%(3/90)]及代谢性骨病中有影像学改变[6.9%(6/87) 比 0]的发生率均高于非BPD组,差异均有统计学意义(P＜0.05).结论 BPD患儿较非BPD早产儿更易合并PVH-IVH、脑白质损伤、PNAC及代谢性骨病等早期肺外并发症,生后早期合理预防及定期监测肺外并发症的发生对提高BPD患儿生存质量至关重要.

Clinical analysis of the early extrapulmonary complications in preterm infants with bronchopulmonary dysplasia

Objective To clinically analyze the incidence of early extrapulmonary complications in premature infants with bronchopulmonary dysplasia(BPD),including periventricular intraventricular hemorrhage(PVH-IVH),white matter injury(WMI),parenteral nutrition associated cholestasis(PNAC) and metabolic bone disease(MBD),in order to direct the prevention and monitoring of these complications in BPD patients.Methods The clinical data of premature infants who were admitted to the neonatal department between September 2014 and December 2015 was retrospectively analyzed.A total of 87 premature infants diagnosed with BPD were studied as BPD group,while other 90 premature infants without BPD who were hospitalized at the same time were randomly selected as non BPD group.The occurrence of several common extrapulmonary complications was compared between two groups,including PVH-IVH,WMI,PNAC and MBD.Results The incidence of PVH-IVH in BPD group increased compared with non BPD group[(26.4%(23/87) vs 11.1%(10/90)] (P＜0.01),grade Ⅰ-Ⅱ PVH-IVH was more often seen in the BPD group too[24.1%(21/87) vs.11.1%(10/90)](P＜0.05),although the difference between two groups regarding the incidence of grade Ⅲ-Ⅳ PVH-IVH was not significant (P＞0.05).The incidence of WMI in BPD group was much higher than that in non BPD group[33.3%(29/87) vs 16.7%(15/90)] (P＜0.05),especially periventricular leukomalacia,the severe type of WMI,was more often found in BPD group than that in non BPD group[13.7%(12/87) vs 2.2%(2/90)](P＜0.05).The incidences of PNAC[22.9%(20/87) vs 5.5%(5/90)],MBD[17.2%(15/87) vs 3.3%(3/90)] and MBD with imaging changes[6.9%(6/87) vs 0] were all higher in BPD group compared with non BPD group,with significant differences between the two groups (P＜0.05).Conclusion BPD patients are more likely to have early extrapulmonary complications like PVH-IVH,WMI,PNAC and MBD than other preterm infants.It is crucial to prevent these complications reasonably and monitor them regularly for the BPD patients in order to improve the quality of life.