小胎龄早产儿支气管肺发育不良发生率和危险因素分析

目的探讨小胎龄早产儿支气管肺发育不良(BPD)的发生率和高危因素。方法回顾性分析2008年5月至2011年12月我院新生儿科收治、胎龄≤32周、且存活28天以上的早产儿临床资料,发生BPD的早产儿为BPD组,按1∶2的比例随机选取未发生BPD的早产儿为对照组。结果共纳入197例早产儿,BPD组28例,BPD发生率14.2%,早产儿随胎龄和出生体重降低BPD发生率明显增加,各胎龄段和体重组差异均有统计学意义(χ2=32.269,30.244,P=0.000)。通过对23个单因素的分析发现,BPD组和对照组胎龄、出生体重、吸氧时间、最高吸入氧浓度、住院时间、气管插管机械通气、应用肺表面活性物质治疗、贫血、使用美罗培南、第10天体重/出生体重比值、氧合指数<300和生后第1次血气评分值12个单因素差异有统计学意义(P均<0.05);多因素Logistic回归分析发现,出生体重低(OR=0.996)、吸氧浓度高(OR=0.898)、第10天体重/出生体重比值小(OR=1.069)为发生BPD的高危因素(P均<0.05)。中重度BPD组与轻度BPD组相比,窒息和使用利尿剂比例高、吸氧时间长、生后第1次血气评分低,差异有统计学意义(P均<0.05)。结论出生体重低、吸入高浓度氧、第10天体重/出生体重比值低为小胎龄早产儿发生BPD的高危因素。

The incidence and risk factors of bronchopulmonary dysplasia in small gestational age premature infants

Objective To analyse bronchopulmonary dysplasia(BPD)incidence and high risk factor in the small gestational age premature infants.Methods Retrospective analyse the materials of inpatient infants whose gestational age(GA)were≤32 weeks and survived over 28 days in our neonatal intensive care unite(NICU).The 28 cases as BPD group met the new diagnostic criteria of BPD.The 56 cases as the control group were randomly selected from all the premature infant with no BPD.Results Total of 197 cases of premature infant were included in this study.The incidence of BPD is about 14.2%.There were statistical significance in each GA period group(χ2=32.269,P=0.000).The incidence increased when the GA decreased;There were statistical significance in each birth weight group (χ2=30.244,P=0.000),the incidence increased when birth weight decreased.From the comparison of the 23 risk factors for BPD,we find that 12 factors have statistical significance(P<0.05),those are GA,body weight,oxygen time,maximum oxygen treatment concentration,hospital days,tracheal intubation mechanical ventilation,replacement therapy with pulmonary surfactant,anemia,application ofMeropenem,the ratio of tenth day body weight to birth weight,the first blood gas analysis scores after birth and oxygen index<300.On the basis of Logistic regression analysis of GA,birth weight,the highest inhaled oxygen volume concentration,tracheal intubation mechanical ventilation,anemia,the ratio of tenth day body weight to birth weight,we find that body weight,the highest inhaled oxygen volume concentration,the ratio of tenth body weight to birth weight are high risk factors for BPD.By compared the 18 factors between mild BPD and moderate or severe BPD,we find that asphyxia, application of diuretic,oxygen time and first blood gas analysis scores after birth have statistical significance(P<0.05).Conclusions The birth weight,the highest inhaled oxygen volume concentration and the ratio of tenth body weight to birth weight are highest risk factor for BPD in small gestational age premature infants.