超低出生体重儿大量肺出血高危因素与临床特征分析

目的 探讨超低出生体重儿(ELBW)大量肺出血(MPH)的常见高危因素,并对其临床特点进行分析。方法 211例ELBW患儿分为MPH组(35例)和无肺出血的对照组(176例)。比较两组临床特征、病死率及并发症的差异,并采用多因素logistic回归分析探讨MPH的高危因素。结果 MPH组患儿胎龄、出生体重及5 min Apgar评分均低于对照组(P0.05),而新生儿呼吸窘迫综合征(RDS)、动脉导管未闭(PDA)、早发型败血症(EOS)及颅内出血的发生率、肺表面活性物质(PS)使用率、病死率均明显高于对照组(P0.01)。多因素logistic回归分析显示,5 min Apgar评分是MPH发生的保护因素(OR=0.666,P0.05),而合并PDA和EOS是MPH发生的危险因素(分别OR=3.717、3.276,均P0.05)。在正常出院的患儿中,MPH组的辅助通气时间长于对照组,呼吸机相关性肺炎(VAP)的发生率高于对照组(P0.05)。结论 较高的5 min Apgar评分可降低ELBW患儿MPH发生的危险,而合并PDA和EOS可增加ELBW患儿MPH发生的危险。MPH患儿机械通气时间更长,病死率及VAP、颅内出血的发生率更高。

High-risk factors and clinical characteristics of massive pulmonary hemorrhage in infants with extremely low birth weight

Objective To explore the high-risk factors and analyze the clinical characteristics of massive pulmonary hemorrhage (MPH) in infants with extremely low birth weight (ELBW). Methods Two hundred and eleven ELBW infants were included in this study. Thirty-five ELBW infants who were diagnosed with MPH were labelled as the MPH group, and 176 ELBW infants without pulmonary hemorrhage were labelled as the control group. The differences in clinical characteristics, mortality rate, and incidence of complications between the two groups were analysed. The high-risk factors for MPH were identiifed by multiple logistic regression analysis. Results The MPH group had signiifcantly lower gestational age, birth weight, and 5-minute Apgar score than the control group (P<0.05). The MPH group had signiifcantly higher rates of neonatal respiratory distress syndrome, patent ductus arteriosus (PDA), early-onset sepsis (EOS), intracranial hemorrhage, pulmonary surfactant utilization, and death compared with the control group (P<0.01). The multiple logistic regression analysis showed that 5-minute Apgar score was a protective factor for MPH (OR=0.666, P<0.05), and that PDA and EOS were risk factors for MPH (OR=3.717, 3.276 respectively;P<0.01). In the infants who were discharged normally, the MPH group had a longer duration of auxiliary ventilation and a higher incidence rate of ventilator-associated pneumonia (VAP) compared with the control group (P<0.05). Conclusions A higher 5-minute Apgar score is associated a decreased risk for MPH, and the prensence of PDA or EOS is associated an increased risk for MPH in ELBW infants. ELBW infants with MPH have a prolonged mechanical ventilation, a higher mortality, and higher incidence rates of VAP and intracranial hemorrhage compared with those without pulmonary hemorrhage.