Risk factors for bronchopulmonary dysplasia in extremely/very low birth weight infants

目的 探讨超低/极低出生体重儿支气管肺发育不良(bronchopulmonary dysplasia,BPD)的危险因素. 方法 2012年1月至201 5年12月北京大学第三医院新生儿重症监护病房收治的出生胎龄＜ 34周且出生体重＜1 500 g、存活≥28 d的超低/极低出生体重儿247例纳入研究.回顾病历资料,按是否诊断BPD分为BPD组(n=107)和非BPD组(n=140).采用两独立样本t检验及x2检验比较组间并发症及治疗情况,采用多因素Logistic回归模型分析BPD的危险因素. 结果 与非BPD组相比,BPD组男婴[61.7％(66/107)与38.6％(54/140),x2=12.967]和1 min Apgar评分＜7分的比例高[33.6％(36/107)与15.0(21/140),x2=11.877],出生胎龄[(28.9±1.7)与(31.3±1.5)周,t=11.295]和出生体重小[(1 106.4±205.1)与(1 293.9±159.7)g,t=7.859](P值均＜0.05).BPD组应用肺表面活性物质治疗、应用气管插管-气管内注入肺表面活性物质-拔管给予鼻塞式无创呼吸技术、有创机械通气≥7d、发生新生儿呼吸窘迫综合征、呼吸暂停、宫内感染性肺炎、呼吸机相关性肺炎、肺出血及动脉导管未闭的比例高于非BPD组,且有创机械通气时间和无创呼吸支持时间更长(P值均＜ 0.05).Logistic回归分析显示,男婴(OR=5.409,95％CI:2.073～14.111)、出生胎龄＜30周(OR=7.472,95％CI:3.027～18.444)、出生体重＜1 000 g(OR=13.029,95％CI:3.134～54.165)、生后l min Apgar评分＜7分(OR=3.410,95％CI:1.168～9.960)、动脉导管未闭(OR=5.390,95％CI:2.217～13.104)、呼吸暂停(OR=3.455,95％CI:1.344～8.877)及呼吸机相关性肺炎(OR=14.318,95％CI:1.923～106.587)为BPD的危险因素(P值均＜ 0.05). 结论 男婴、超低出生体重儿是BPD的高危人群,尽可能减少其有创机械通气的持续时间,早期治疗呼吸暂停,积极关闭动脉导管,减少并积极控制感染的发生,也许有助于降低BPD的发生率及危险程度.Objective To analyze the risk factors for bronchopulmonary dysplasia (BPD) in extremely/very low birth weight infants (ELBWI/VLBW1).Methods Data of 247 ELBWI/VLBWI admitted to the Neonatal Intensive Care Unit of Peking University Third Hospital from January 2012 to December 2015,with gestational age ＜34 weeks and birth weight ＜1 500 g,who survived over 28 days,were studied retrospectively.They were divided into BPD group (n=107) and non-BPD group (n=140).The clinical data were compared between the two groups by two sample t-test and Chi-square test,and risk factors of BPD were analyzed by multivariate Logistic regression.Results Compared with non-BPD group,BPD group had more cases of male gender [61.7％ (66/107) vs 38.6％ (54/140),x2=12.967],a higher incidence of 1 min Apgar score ＜7 [33.6％ (36/107) vs 15.0 (21/140),x2=11.877],smaller gestational age [(28.9± 1.7) vs (31.3± 1.5) weeks,t=l 1.295] and lower birth weight [(1 106.4±205.1) vs (1 293.9± 159.7) g,t=-7.859] (all P＜0.05).The proportion of administration of pulmonary surfactant and intubation-surfactant-extubation,and invasive ventilation ≥ 7 days,and incidence of intrauterine infectious pneumonia,neonatal respiratory distress syndrome,apnea,ventilator-associated pneumonia,pulmonary hemorrhage and patent ductus arteriosus in BPD group were higher than those in non-BPD group.Moreover,the duration of invasive ventilation and duration of noninvasive ventilation were also longer (all P＜0.05).Multivariate Logistic regression revealed that male gender (OR=5.409,95％CI:2.073-14.111),gestational age ＜30 weeks (OR=7.472,95％CI:3.027-18.444),birth weight ＜1 000 g (OR=13.029,95％CI:3.134-54.165),1 min Apgar score ＜7 (OR=3.410,95％CI:1.168-9.960),and patent ductus arteriosus (OR=5.390,95％CI:2.217 13.104),apnea (OR=3.455,95％CI:1.344-8.877) and ventilator-associated pneumonia (OR=14.318,95％CI:1.923-106.587) were the risk factors of BPD (all P＜0.05).Conclusions Male and low birth weight neonates are high risk factors for BPD.Reduction of the duration of invasive ventilation,and early and proper treatment of apnea and patent ductus arteriosus and active control of infection may be helpful in decreasing the incidence of BPD.国家自然科学基金(81302435)National Science Foundation of China中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)10761-7651