早产儿支气管肺发育不良高危因素及防治对策

目的:分析早产儿支气管肺发育不良(BPD)的高危因素,探讨防治措施。方法:回顾性分析我院新生儿科2005年10月-2010年11月期间收治的胎龄≤32周且出生体质量≤1500g,存活时间>28d的早产儿110例的临床资料,需要应用机械通气治疗75例,其中14例诊断为早产儿支气管肺发育不良(为BPD组),61例为非BPD组。比较分析患儿的胎龄、出生时体质量、生前应用糖皮质激素、生后应用肺表面活性物质、窒息史、胎膜早破史、机械通气时间、吸氧时间、动脉导管未闭、反复肺部感染等临床资料。结果:早产儿支气管肺发育不良的发生率占所有住院早产儿的12.73%(14/110).BPD组患儿生前应用糖皮质激素、生后应用肺表面活性物质、窒息史,与非BPD组比较无明显差异性(P>0.05);而BPD组患儿的胎膜早破、动脉导管未闭、反复肺部感染与非BPD组比较差异有显著性(P<0.05),具有统计学意义;BPD组患儿的胎龄、出生时体质量、机械通气时间、吸氧时间与非BPD组比较差异有明显显著性(P<0.01),具有统计学意义。结论:避免早产及低出生体质量儿、尽量缩短机械通气时间及氧气吸入时间、防止及减少反复肺部感染,积极早期综合治疗是预防早产儿支气管肺发育不良的重要措施。

High Risk Factor and Preventive Treatment Countermeasures of Premature with Bronchopulmonary Dysplasia

Objective:To explored the high risk factor and preventive treatment countermeasures of premature with bronchopulmonary dysplasia.Methods:Retrospectived analyses the data of 110 premature cases in the department of paediatrics from October 2005 to November 2010.The cases: gestational age were less than or equal to 32 weeks,birth weight were less than or equal to 1500 grams,survival time greater than 28 days.75 cases need the treatment of mechanical ventilation.In the 75cases,14 cases were diagnosed as bronchopulmonary dysplasia(group BPD),the rest of 61cases as group NO-BPD.Comparative analyzed the gestational age,birth weight,use corticosteroids before birth,use pulmonary surfactant after birth,suffocation history,premature rupture of membrane history,the time of mechanical ventilation,oxygen time,patent ductus arteriosus and frequently lung infection between the two groups.Results:The rates of bronchopulmonary dysplasia were 12.73%(14/110).The difference of use corticosteroids before birth,use pulmonary surfactant after birth and suffocation history between the two groups wasn’t statistically significant(P>0.05).There was statistically significant of the difference of premature rupture of membrane history patent ductus arteriosus and frequently lung infection between the two groups(P<0.05).There was statistically significant of the difference of gestational age,birth weight,the time of mechanical ventilation and oxygen time between the two groups(P<0.01).Conclusion:To avoid premature delivery and low birth weight infant,shorten the time of mechanical ventilation and oxygen inhalation,prevent and reduce frequently lung infection and actively early phase comprehensive treatment were the important factors to prevent premature bronchopulmonary dysplasia.