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目的分析支气管肺发育不良(BPD)早产儿的临床特点及高危因素,探讨BPD的防治措施。方法回顾性分析2009年1月至2012年12月本院NICU收治的极低出生体重早产儿临床资料,最终诊断BPD的早产儿为BPD组,同期未患BPD的早产儿为对照组,比较两组患儿围产期病史、临床表现、治疗、并发症及新生儿期结局。结果研究期间共收治极低出生体重早产儿227例,159例在本院救治并存活至28天,纳入研究,其中44例早产儿诊断BPD(27.7%),轻度36例(81.8%)。单因素分析显示,与对照组比较,BPD组患儿出生胎龄小,出生体重低,男性、宫内感染、新生儿呼吸窘迫综合征(RDS)、动脉导管未闭(PDA)、医院感染比率高,接受辅助通气时间长,差异有统计学意义(P<0.05);两组以病理学为依据的绒毛膜羊膜炎及胎儿炎症差异无统计学意义(P>0.05)。将出生胎龄<32周、出生胎龄<30周、出生体重<1 000 g、使用呼吸机、RDS及分期、PDA、肺炎、宫内感染、母亲胎盘绒毛膜羊膜炎、医院感染、性别与BPD发生的关系作多因素Logistic回归分析,发现出生胎龄<30周(OR 9.629,95%CI 2.767~33.513)及男性(OR 3.047,95%CI 1.037~8.948)是BPD发生的高危因素。结论避免早产、合理通气策略、预防和控制感染可能减少BPD发生,远期随访更重要。
Objective To analyze the clinical features and risk factors of premature infants with bronchopulmonary dysplasia (BPD) and to explore the prevention and treatment measures of BPD. Methods The clinical data of very low birth weight preterm infants admitted to NICU from January 2009 to December 2012 in our hospital were analyzed retrospectively. The final diagnosis of BPD was BPD, and the premature infants without BPD were control. Group of patients with perinatal history, clinical manifestations, treatment, complications and neonatal outcome. Results A total of 227 preterm infants with very low birth weight were admitted during the study period, and 159 of them were treated and survived to 28 days in our hospital. Among 44 preterm infants, BPD was diagnosed (27.7%) and mild (81.8%). Univariate analysis showed that gestational age, birth weight, male, intrauterine infection, neonatal respiratory distress syndrome (RDS), patent ductus arteriosus (PDA), nosocomial infection rate (P <0.05). There was no significant difference between the two groups in pathological chorioamnion and fetal inflammation (P> 0.05). The gestational age at birth was less than 32 weeks, the gestational age at birth was less than 30 weeks, and the birth weight was less than 1 000 g. Respiratory rate, RDS and staging, PDA, pneumonia, intrauterine infection, maternal placental chorioamnionitis, nosocomial infections, Logistic regression analysis showed that the gestational age at birth <30 weeks (OR 9.629,95% CI 2.767 ~ 33.513) and men (OR 3.047,95% CI 1.037 ~ 8.948) were the risk factors for BPD. Conclusion Preventing premature delivery, rational ventilation strategy, prevention and control of infection may reduce the incidence of BPD, long-term follow-up is more important.