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目的了解支气管肺发育不良(BPD)的临床特征和高危因素,为BPD的预防和治疗提供借鉴。方法选择入住华盛顿大学医学院圣路易斯儿童医院新生儿重症监护室的胎龄≤34周、住院时间≥28d早产儿的临床资料进行回顾性分析。结果共337例患儿符合纳入标准,其中146例发生BPD(43.3%),为BPD组,85例出院后需继续家庭氧疗;191例未发生BPD,为对照组。BPD组的胎龄、出生体质量及1分钟Apgar评分均低于对照组,而机械通气时间、需中心静脉置管时间、住院时间均长于对照组,各种其他并发症如早产儿视网膜病、动脉导管未闭、呼吸窘迫综合征、颅内出血、脑室周围白质软化的发生率、病死率均明显高于对照组。Logistic回归分析发现,出生体质量和1分钟Apgar评分为保护因素,呼吸机相关性肺炎、动脉导管未闭、早产儿视网膜病为危险因素。结论BPD可能是导致早产儿住院时间延长及后期死亡的原因之一;预防出生时窒息、尽可能控制动脉导管未闭和呼吸机相关性肺炎的发生,可能会降低BPD的发生。
Objective To understand the clinical features and risk factors of bronchopulmonary dysplasia (BPD) and provide references for the prevention and treatment of BPD. Methods We retrospectively analyzed the clinical data of premature infants who were ≤34 weeks of gestational age and ≥28 days of hospital stay at the St. Louis Children’s Hospital of Washington University School of Medicine. Results A total of 337 children were eligible for inclusion. Among them, 146 cases developed BPD (43.3%), which was BPD group. 85 patients needed to continue home oxygen therapy after discharge and 191 cases had no BPD as control group. The gestational age, birth weight and 1-minute Apgar score of BPD group were lower than those of the control group, but the mechanical ventilation time, central venous catheterization time and hospitalization time were longer than the control group, and other complications such as retinopathy of prematurity, Patent ductus arteriosus, respiratory distress syndrome, intracranial hemorrhage, periventricular white matter degeneration and mortality were significantly higher than the control group. Logistic regression analysis found that birth weight and 1-minute Apgar score were risk factors for protection factors, ventilator-associated pneumonia, patent ductus arteriosus, and retinopathy of prematurity. Conclusions BPD may be one of the reasons leading to prolonged hospital stay and later death in preterm infants. Preventing birth asphyxia and controlling as far as possible the patent ductus arteriosus and ventilator - associated pneumonia may reduce the incidence of BPD.