摘要目的 探析早产儿支气管肺发育不良(BPD)的危险因素.方法 应用前瞻性队列研究的方法,对2013年11月至2014年5月入住南方医科大学北京军区总医院临床医学院附属八一儿童医院新生儿科极早产病房胎龄＜32周,出生24 h内入院且存活至出生28 d以上的早产儿进行研究.按是否确诊BPD分为2组(BPD组、非BPD组),比较2组间孕母情况、新生儿基本情况及疾病和治疗情况的差异.采用t检验、x2检验、Fisher's确切概率法及Logistic回归模型分析早产儿BPD的危险因素.结果 1.共纳入对象298例.其中男180例,女118例;胎龄25.6 ～31.9(29.9±1.4)周;出生体质量740～2 300(1 428.3±289.0)g,超低出生体质量儿19例,极低出生体质量儿175例.确诊BPD 69例(轻度43例,中度10例,重度16例),BPD发生率为23.2％.2.BPD的发生与胎龄及出生体质量呈负相关:＜28周、28～ 30周、≥30～32周BPD发病率分别为70.4％、41.9％和6.2％;出生体质量＜1 000 g、1 000～1 500 g、≥1 500～1 800 gBPD发病率分别为78.9％、29.5％和8.8％.3.多因素Logistic逐步回归得出胎龄(OR=4.52)、出生体质量(OR =3.38)、性别(OR=3.04)、巨细胞病毒感染(OR=55.27)、气管插管通气天数≥7 d(OR=3.22)、最高吸入氧体积分数≥400 mL/L(OR =4.14)、手术治疗动脉导管未闭(PDA)(OR =7.30)、出生14 d内输注红细胞(OR=3.51)为独立危险因素(P均＜0.05).4.出生体质量(P=0.015)、气管插管通气时间(P=0.003)、吸氧时间(P=0.000)、是否手术治疗关闭PDA(P=0.017)与BPD发生的严重程度有关.结论 早产儿BPD为多因素疾病,针对危险因素采取有效的干预措施是预防BPD的关键.

abstractsObgective To explore the risk factors of preterm infants with bronchopulmonary dysplasia(BPD).Methods A prospective cohort study was conducted to analyze the risk factors of preterm infants with BPD.Preterm infants (gestational age ＜ 32 weeks,and admission within 24 h since birth,and survival time more than 28 d since birth) who were sent to the Ward of Extremely Preterm Infants in Bayi Children's Hospital Affiliated to Clinical Medical College in Beijing Military General Hospital of Southern Medical University were enrolled from November 2013 to May 2014.According to the diagnostic criteria of BPD,the subjects were divided into 2 groups(BPD group and non-BPD group).Factors such as maternal information,neonatal basic information,neonatal diseases and treatments were compared between the 2 groups.Risk factors of preterm infants with BPD were analyzed by using t test,Chi-square test,Fisher's exact probability method and Logistic regression analysis.Results (1) A total of 298 cases were enrolled in this study.Among these infants,180 cases were male and 118 cases were female.The gestational age ranged from 25.6 to 31.9 weeks with the average age of (29.9 ± 1.4) weeks and the birth weights ranged from 740 to 2 300 g with the average weight of (1 428.3 ± 289.0) g.There were 19 cases of extremely low birth weight and 175 cases of very low birth weight.Sixty-nine cases of these infants were diagnosed as BPD (43 cases were mild,10 cases were moderate,16 cases were severe) with incidence of 23.2％.(2)The incidence of BPD was negatively related to gestational age and birth weight:the incidence of BPD in preterm infants with gestational age ＜ 28 weeks,28-30 weeks and ≥ 30-32 weeks were 70.4％,41.9％ and 6.2％;the incidence of BPD in preterm infants with birth weight ＜ 1 000 g,1 000-1 500 g and ≥ 1 500-1 800 g were 78.9％,29.5％ and 8.8％.(3) Multivariate Logistic regression found gestational age (OR =4.52),birth weight (OR =3.38),gender (OR =3.04),cytomegalovirus infection (OR =55.27),duration of invasive ventilation ≥ 7 d (OR =3.22),the highest concentration of inspired oxygen ≥400 mL/L (OR =4.14),patent ductus arteriosus(PDA) in need of surgical ligation (OR =7.30),and transfusion of packed red blood cells within 14 d since birth (OR =3.51) were the independent risk factors of BPD (all P ＜ 0.05).(4) Factors such as birth weight (P =0.015),duration of invasive ventilation (P =0.003),duration of inspired oxygen (P =0.000),and PDA in need of surgical ligation or not(P =0.017) were related to the severity of BPD.Conclusions BPD is a multifactorial disease.Taking effective measures to control risk factors is the key for preventing BPD.