呼吸窘迫综合征并发支气管肺发育不良危险因素分析

目的：探讨呼吸窘迫综合征（RDS）患儿支气管肺发育不良（BPD）的危险因素。方法：对该院2000年1月至2005年8月应用呼吸机治疗并住院28 d以上的呼吸窘迫综合征患儿进行回顾性分析，比较并综合分析20余种高危因素与BPD的关系。结果：72例呼吸机治疗、住院＞28 d呼吸窘迫综合征患儿BPD发生率为23.6%（17/72），BPD 组 FiO2，PIP，PEEP，MAP，上机日龄、产前应用地塞米松促肺成熟、生后应用肺表面活性物质（PS）等与对照组差异无显著性（P＞0.05），而胎龄≤30周、出生体重≤1 250 g、上机次数≥2次、合并肺炎、肺出血、上机天数≥5 d、痰培养阳性2次以上等与对照组差异有显著性（P<0.05）；多因素Logistic回归显示：出生体重≤1 250 g、机械通气≥10 d，痰培养阳性3次以上为发生BPD的独立危险因素。结论：避免低体重早产儿、缩短应用机械通气时间、防止及减少肺部感染，尤其是严重感染是预防RDS发生BPD的重要措施。［中国当代儿科杂志，2007，9（1）：15-18］

Risk factors for bronchopulmonary dysplasia in neonates with respiratory distress syndrome

OBJECTIVE: To identify the risk factors for bronchopulmonary dysplasia (BPD) in neonates with respiratory distress syndrome (RDS). METHODS: Data from 72 patients with RDS (birth weight 1607 +/- 277 g; gestational age 29.47 +/- 2.54 weeks) who were hospitalized for >28 days and who received mechanical ventilation treatment between January 2001 and August 2005 were studied retrospectively. A logistic regression analysis was used to identify the risk factors associated with the development of BPD. RESULTS: Of the 72 patients, 17 developed BPD (23.6%). Uniovariate analysis revealed that in addition to a gestational age of < or = 30 weeks and a birth weight below 1250 g, the times of mechanical ventilation treatment (> or = 2 times), concurrent pulmonary infection and pneumorrhagia, prolonged mechanical ventilation (> or = 5 days), and positive sputum bacterial cultures on 2 occasions were all associated with an increase in the incidence of BPD. Multivariate logistic analysis revealed that birth weight below 1250 g, prolonged mechanical ventilation (> or = 10 days),and positive sputum cultures on 3 or more occasions were independent risk factors for BPD (OR=6.614,14.997 and 39.752 respectively). CONCLUSIONS: The risk for BPD is multifactorial. Preventing small gestational age and low birth weight prematurity, decreasing the duration of mechanical ventilation and treatment of pulmonary infection are necessary to prevent BPD.