早产儿支气管肺发育不良的临床影响因素研究

目的探讨早产儿支气管肺发育不良(BPD)的临床影响因素.方法选取在该院新生儿重症监护病房(NICU)接受治疗的被诊断为BPD的85例早产儿作为观察组,在未发生BPD的早产儿中选取患儿母亲一般情况及患儿出生情况相匹配的85例作为对照组.对两组早产儿的一般情况、原发疾病/并发症、治疗情况、新生儿危重病例评分(NCIS)、血清25-羟维生素D[25-(OH)D]及母亲血清25-(OH)D水平进行对比,分析BPD的相关影响因素.结果观察组早产儿呼吸窘迫综合征(NRDS)、呼吸机相关肺炎(VAP)、电解质紊乱、重度脑室周—脑室内出血(PVH-IVH)、动脉导管未闭(PDA)、胃肠道外营养相关胆汁淤积(PNAC)、有创通气、输血≥3次、手术治疗发生率均显著高于对照组,开始肠内喂养时间明显长于对照组(P<0.05).观察组早产儿血清25-(OH)D、母亲血清25-(OH)D水平及NCIS评分均显著低于对照组(P<0.05).多因素回归分析显示:PDA、电解质紊乱、有创通气、手术治疗均是BPD发生的独立高危因素,早产儿血清25-(OH)D、母亲血清25-(OH)D、NCIS评分均是BPD发生的保护性因素(均P<0.05).结论PDA、电解质紊乱、有创通气、早产儿及母亲维生素D缺乏、NCIS评分低下均是影响早产儿发生BPD的临床高危因素,孕妇尽早补充维生素D对于预防早产儿BPD的发生具有积极作用.

Study on influencing factors of bronchopulmonary dysplasia in premature infants

Objective To explore the clinical influencing factors of bronchopulmonary dysplasia(BPD)in premature infants.Methods 85 cases of premature infants diagnosed as BPD were selected as the observation group,and 85 cases of premature infants without BPD were selected as the control group.The general conditions,primary diseases/complications,treatment,NCIS,25 hydroxyvitamin D[25-(OH)D]levels in serum and 25-(OH)D levels in maternal serum of the two groups were compared,and the relevant influencing factors of BPD were analyzed.Results The incidences of respiratory distress syndrome(NRDS),ventilator-associated pneumonia(VAP),electrolyte disorder,severe periventricular intraventricular hemorrhage(PVH-IVH),patent ductus arteriosus(PDA),parenteral nutrition-related cholestasis(PNAC),invasive ventilation,blood transfusion≥3 times and surgical treatment in the observation group were significantly higher than that in the control group,and the time of starting enteral feeding was significantly longer than that in the control group(P<0.05).The levels of serum 25-(OH)D,maternal 25-(OH)D and NCIS in the observation group were significantly lower than those in the control group(P<0.05).Logistic regression analysis.The results showed that PDA,electrolyte disorder invasive ventilation and surgical treatment were independent high-risk factors of BPD.The serum 25-(OH)D of premature infants,serum 25-(OH)D of mothers and NCIS scores were all protective factors of BPD(P<0.05).Conclusion PDA,electrolyte disorder,invasive ventilation,vitamin D deficiency in preterm infants and mothers,and low NCIS scores are the clinical risk factors of BPD in preterm infants.Early supplementation of vitamin D in pregnant women has a positive effect on the prevention of BPD in preterm infants.