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目的分析早产儿支气管肺发育不良(BPD)的发生率和危险因素,探讨防治BPD的措施。方法回顾性分析中山大学第一附属医院新生儿科1999年6月至2004年6月期间胎龄≤32周且出生体重≤2000g,存活时间>28d的早产儿72例,比较机械通气治疗中15例BPD(BPD组)和31例非BPD(对照组)患儿性别、胎龄、出生体重、生前使用糖皮质激素、生后使用肺表面活性物质、肺透明膜病、机械通气时间、呼吸支持条件、胃食管反流、动脉导管未闭、生后早期液体摄取量、反复肺部感染情况。结果早产儿BPD的总发生率为20.83%(15/72),其中<1500g早产儿BPD的发生率为38.71%(12/31);BPD组FiO2、PIP、PEEP和MAP与对照组差异无显著性意义(P>0.05);多因素Logistic回归显示,胎龄<30周、体重<1250g、机械通气≥10d和反复肺部感染是发生BPD的独立危险因素(P<0.05),而性别、生前使用糖皮质激素、生后使用肺表面活性物质、肺透明膜病、胃食管反流、动脉导管未闭、生后早期液体摄取量没有统计学意义(P>0.05)。结论避免低体重早产、长时间机械通气和有效控制肺部感染是防治BPD的关键。
Objective To analyze the incidence and risk factors of bronchopulmonary dysplasia (BPD) in preterm infants and to explore the measures to prevent and treat BPD. Methods 72 cases of premature infants of gestational age ≤32 weeks with birth weight ≤2000g and survival time> 28d were retrospectively analyzed in Department of Neonatology, the First Affiliated Hospital of Sun Yat-sen University from June 1999 to June 2004. Fifteen cases of mechanical ventilation were compared BPD (BPD group) and 31 non-BPD (control group) children with gender, gestational age, birth weight, pre-use glucocorticoid, pulmonary surfactant, hyaline membrane disease, mechanical ventilation time, respiratory support , Gastroesophageal reflux, patent ductus arteriosus, early postnatal fluid intake, recurrent lung infections. Results The overall incidence of BPD in preterm infants was 20.83% (15/72), of which the incidence of BPD in preterm infants <1500g was 38.71% (12/31). There was no significant difference between FiO2, PIP, PEEP and MAP in BPD (P> 0.05). Multivariate Logistic regression showed that gestational age <30 weeks, body weight <1250g, mechanical ventilation ≥10 days and recurrent pulmonary infection were independent risk factors for BPD (P <0.05) The use of glucocorticoids, pulmonary surfactant, hyaline membrane disease, gastroesophageal reflux, patent ductus arteriosus, early postnatal fluid uptake had no statistical significance (P> 0.05). Conclusions Avoiding low birth weight, prolonged mechanical ventilation and effective control of lung infection are the key to prevention and treatment of BPD.