早产儿支气管肺发育不良的高危因素及预防对策

目的分析早产儿支气管肺发育不良症(BPD)的发生率和高危因素,探讨BPD的诊治措施。方法回顾分析苏州大学儿童医院2002-01—2006-10在NICU诊治的孕周<32周的极低出生体重儿145例的临床资料。71例均有机械通气史,其中13例诊断为BPD(BPD组),而58例为非BPD组,对两组临床资料进行对照研究。结果孕周<32周的极低出生体重儿BPD的总发生率是10.34%,而有气管插管呼吸机辅助呼吸史的极低出生体重儿BPD的发生率高达18.31%。BPD组患儿胎龄和产重均较非BPD组低,胎膜早破史及合并PDA者BPD组均较对照组明显增高,有统计学意义(P<0.05);入院时间、肺表面活性物质(PS)的应用、有无窒息史均无明显差异,P>0.05;两组患儿在高浓度吸氧、PIP、PEEP及MAP几个呼吸机参数上差异无显著性(P>0.05),而上机时间和吸氧时间在两组间差异有显著性(P<0.05)。结论避免早产低体重、长时间吸氧机械通气、控制肺部反复感染是防止BPD的关键,积极早期综合治疗BPD疗效肯定,小剂量激素治疗有较好效果。

The high-risk factors and prevention for bronchopulmonary dysplasia in premature infants

Objective To study the high-risk factors and prevention for bronchopulmonary dysplasia (BPD) in premature infants.Methods From January 2002 to October 2006 one hundred and ninety-nine very low birth weight infants with gestational age less than 32 weeks in our NICU were enrolled in the study.Seventy-one cases had the histories of mechanical ventilation,thirteen with BPD were compared to fifty-eight ones without BPD in the clinical materials.Results The total incidence of BPD in the very low birth weight infants with gestational age less than 32W was 10.3%,and 18.31% in those infants with mechanical ventilation.The gestational age and birth weight of BPD group were lower than those without BPD,and the rates of amniocentesis and complicated PDA in BPD group were higher than those of the control( P<0.05); the time in hospital,the use of PS,asphyxia history,high oxygen concentration,PIP,PEEP and MAP have not been found more different between the two groups(P>0.05).The time of mechanical ventilation and oxygen administration were longer in BPD group (P<0.05).Conclusion Preventing premature labor,shortening the duration of mechanical ventilation and oxygen administration and managing the recurrent infection of lung effective in preventing BPD.Low dosage of steroids has good effect on BPD.