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目的探讨小胎龄早产儿支气管肺发育不良(BPD)的发生率和高危因素。方法回顾性分析2008年5月至2011年12月我院新生儿科收治、胎龄≤32周、且存活28天以上的早产儿临床资料,发生BPD的早产儿为BPD组,按1∶2的比例随机选取未发生BPD的早产儿为对照组。结果共纳入197例早产儿,BPD组28例,BPD发生率14.2%,早产儿随胎龄和出生体重降低BPD发生率明显增加,各胎龄段和体重组差异均有统计学意义(χ2=32.269,30.244,P=0.000)。通过对23个单因素的分析发现,BPD组和对照组胎龄、出生体重、吸氧时间、最高吸入氧浓度、住院时间、气管插管机械通气、应用肺表面活性物质治疗、贫血、使用美罗培南、第10天体重/出生体重比值、氧合指数<300和生后第1次血气评分值12个单因素差异有统计学意义(P均<0.05);多因素Logistic回归分析发现,出生体重低(OR=0.996)、吸氧浓度高(OR=0.898)、第10天体重/出生体重比值小(OR=1.069)为发生BPD的高危因素(P均<0.05)。中重度BPD组与轻度BPD组相比,窒息和使用利尿剂比例高、吸氧时间长、生后第1次血气评分低,差异有统计学意义(P均<0.05)。结论出生体重低、吸入高浓度氧、第10天体重/出生体重比值低为小胎龄早产儿发生BPD的高危因素。
Objective To investigate the incidence and risk factors of bronchopulmonary dysplasia (BPD) in small gestational age premature infants. Methods The clinical data of premature infants who were admitted to neonatology department of our hospital from May 2008 to December 2011 with gestational age ≤ 32 weeks and survived more than 28 days were retrospectively analyzed. The proportion of randomly selected premature children without BPD as control group. Results A total of 197 premature infants were enrolled in this study. 28 cases of BPD patients were treated with BPD, the incidence of BPD was 14.2%. The incidence of BPD in gestational age and birth weight was significantly increased in preterm infants. There was significant difference in each gestational age group and weight group (χ2 = 32.269, 30.244, P = 0.000). Through 23 univariate analysis found that gestational age, birth weight, oxygen inhalation time, the highest inhaled oxygen concentration, hospital stay, endotracheal intubation mechanical ventilation, the application of pulmonary surfactant therapy, anemia, the use of the United States BPD group and the control group (P <0.05). Logistic regression analysis showed that the birth weight, birth weight, body mass index, birth weight and body mass index were all significantly different (OR = 0.996), high oxygen concentration (OR = 0.898) and small body weight to birth weight (OR = 1.069) on day 10 were the risk factors for developing BPD (all P <0.05). Compared with the mild BPD group, the moderate to severe BPD group had higher rates of asphyxia and diuretics, longer oxygen inhalation time and lower first blood gas score after birth (P <0.05). Conclusions Low birth weight and high concentration of oxygen inhalation, low body weight to birth weight ratio on day 10 are risk factors for BPD in preterm infants of small gestational age.