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早产儿支气管肺发育不良发病及随访情况分析

Analysis of incidence and follow-up of bronchopulmonary dysplasia in premature infants

摘要:

目的 研究早产儿支气管肺发育不良(BPD)的发病及随访情况,为BPD的防治提供临床依据.方法 采用回顾性队列研究分析2012年1月至2015年3月北京大学第一医院住院治疗的BPD患儿资料.将患儿分为轻度组和中重度组,对2组患儿住院及随访期情况进行比较和分析.结果 共纳入早产儿1 325例,其中BPD患儿47例,BPD发病率为3.5%.其中轻度组26例,中重度组21例.中重度组患儿出生体质量显著低于轻度组[(1 059.1±195.6)g比(1 285.8±238.5)g],差异有统计学意义(t=3.505,P<0.01);中重度组患儿住院时间、用氧时间、机械通气和无创呼吸支持相关参数及时间、地塞米松治疗比例均高于轻度组[住院时间:(81.9±38.1)d比(49.9±13.2)d;用氧时间:74.0(57.0,97.3)d比35.0(29.5,39.5)d;机械通气时间:300.0(99.0,646.8)h比143.5(24.3,223.5)h;机械通气最高吸入氧体积分数(FiO2):0.48 (0.36,0.69)比0.40(0.25,0.49);机械通气最高平均呼吸道压12.4(10.0,15.0) cmH2O比9.9(8.1,12.8) cmH2O(1 cmH2O=0.098 kPa);无创呼吸支持时间:754.5(252.0,925.8)h比357.5(242.5,607.3)h;无创呼吸支持最高FiO2:0.30(0.25,0.35)比0.25(0.21,0.30);地塞米松治疗:18例(85.7%)比9例(34.6%)],差异均有统计学意义(均P<0.05);出院时轻度组2例、中重度组9例未离氧,2组比较差异有统计学意义(x2=6.172,P<0.05).校正年龄1岁内轻度组发生下呼吸道感染9例(13次),中重度组为6例(10次),2组比较差异无统计学意义(P>0.05).校正年龄1岁,中重度组体质量、身高、头围百分位数情况均低于轻度组[体质量:2.0(1.0,4.0)比4.5(3.0,6.3);身长:3.0(1.0,4.5)比5.0(3.0,6.3);头围:3.0(2.0,4.0)比5.0(4.0,6.0)],差异均有统计学意义(均P<0.05);Gesell评估提示5个能区组间比较差异均无统计学意义(均P>0.05).结论 中重度BPD患儿出生体质量低,住院时间及用氧时间长,机械通气相关参数较高,体格发育落后较多.BPD患儿出院后的呼吸系统状况及神经发育情况需长期随访.

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abstracts:

Objective To study the incidence and follow-up of premature infants with bronchopulmonary dysplasia (BPD),in order to provide clinical evidence for its prevention and treatment.Methods Clinical data of patients with BPD in Peking University First Hospital from January 2012 to March 2015 were analyzed with retrospectivecohort study.BPD infants were classified as mild and moderate/severe group according to the criteria.The incidence,clinical features,treatment,comorbidities,and outcome of the 2 groups during hospitalization and follow-up periods were compared.Results One thousand three hundred and twenty-five newborns were enrolled,and 47 cases met the criteria of BPD,the incidence rate was 3.5 %.Twenty-six cases were diagnosed as mild BPD,and 21 cases were diagnosed as moderate/severe BPD.The birth weight of the moderate/severe group was statistically lower than that of the mild group [(1 059.1 ± 195.6) g vs.(1 285.8 ± 238.5) g,t =3.505,P < 0.01].The length of stay,duration of oxygen therapy,parameters and time related to mechanical ventilation,noninvasive respiratory support,and Dexamethasone treatment percentage in the moderate/severe group were statistically higher than those in the mild group [the length of stay:(81.9 ± 38.1) d vs.(49.9 ± 13.2) d;duration of oxygen therapy:74.0 (57.0,97.3) d vs.35.0 (29.5,39.5) d;duration of mechanical ventilation:300.0 (99.0,646.8) h vs.143.5 (24.3,223.5) h;the highest fraction of inspiration oxygen (FiO2) of mechanical ventilation:0.48 (0.36,0.69) vs.0.40 (0.25,0.49);the highest mean airway pressure during mechanical ventilation:12.4 (10.0,15.0) cmH2O vs.9.9 (8.1,12.8) cmH2O (1 cmH2O =0.098 kPa);duration of noninvasive respiratory support:754.5 (252.0,925.8) h vs.357.5 (242.5,607.3) h;the highest FiO2 of noninvasive respiratory support:0.30 (0.25,0.35) vs.0.25 (0.21,0.30);Dexamethasone treatment:18 cases (85.7%) vs.9 cases(34.6%)] (all P < 0.05).Two cases in the mild group and 9 cases in the moderate/severe group needed home oxygen therapy after hospital discharge,and the difference was significant between the 2 groups (x2 =6.172,P <0.05).Follow-up to 1 year corrected age,the lower respiratory tract infection times were 13 (9 cases) in the mild group,and 10 (6 cases) in the moderate/severe group,but there was no significant difference between the 2 groups (P > 0.05).At 1 year corrected age,the percentile of body weight,body length,and head circumference in the growth curve in the moderate/severe group were statistically lower than those in the mild group [body weight:2.0 (1.0,4.0) vs.4.5 (3.0,6.3);body length:3.0 (1.0,4.5) vs.5.0 (3.0,6.3);head circumference:3.0 (2.0,4.0) vs.5.0 (4.0,6.0)],and the differences were significant (all P < 0.05);Gesell Developmental Schedules showed that there were no statistically significant differences between mild group and moderate/severe group in 5 different strands(all P > 0.05).Conclusions Infants with moderate/severe BPD have lower birth weight,higher mechanical ventilation related parameters,longer length of stay and oxygen therapy,and more retardation of physical development.The respiratory system health and neurological development of BPD infants after discharge need a long term follow-up.

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