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中华妇幼临床医学杂志(电子版) ›› 2017, Vol. 13 ›› Issue (05) : 518 -523. doi: 10.3877/cma.j.issn.1673-5250.2017.05.004

所属专题： 文献；

论著

极低出生体重儿支气管肺发育不良影响因素分析
张林1, 杨晓燕2, 石晶2,†()   
  1. 1. 610041　成都，四川大学华西第二医院儿科；641400　四川，简阳市人民医院新生儿科
    2. 610041　成都，四川大学华西第二医院儿科
  • 收稿日期:2017-06-08 修回日期:2017-08-25 出版日期:2017-10-01
  • 通信作者: 石晶

Analysis of influencing factors of very low birth weight infants with bronchopulmonary dysplasia

Lin Zhang1, Xiaoyan Yang2, Jing Shi2,†()   

  1. 1. Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China；Department of Neonatology, People′s Hospital of Jianyang City, Jianyang 641400, Sichuan Province, China
    2. Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
  • Received:2017-06-08 Revised:2017-08-25 Published:2017-10-01
  • Corresponding author: Jing Shi
  • About author:
    Corresponding author: Shi Jing, Email:
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引用本文：

张林, 杨晓燕, 石晶. 极低出生体重儿支气管肺发育不良影响因素分析[J/OL]. 中华妇幼临床医学杂志(电子版), 2017, 13(05): 518-523.

Lin Zhang, Xiaoyan Yang, Jing Shi. Analysis of influencing factors of very low birth weight infants with bronchopulmonary dysplasia[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2017, 13(05): 518-523.

目的

探讨极低出生体重儿(VLBWI)发生支气管肺发育不良(BPD)的影响因素。

方法

选择2015年1月至12月，四川大学华西第二医院新生儿重症监护室收治的163例VLBWI为研究对象。按照出院诊断是否包括BPD，将其分为BPD组(n＝57)及非BPD组(n＝106)。回顾性分析VLBWI临床病例资料，统计学比较下面各项因素对于VLBWI发生BPD的影响。①2组VLBWI母亲产前一般临床资料，包括年龄、胎次、是否初产妇、是否多胎妊娠、是否按期规律进行产前检查、分娩时并发症发生情况、分娩方式等12项因素；②新生儿情况，包括胎龄，出生体重，性别，出生后1 min及5 min Apgar评分，出生后肺表面活性物质(PS)使用情况，机械通气使用率及时间，以及生后合并症发生情况等14项因素。根据临床经验及VLBWI发生BPD的单因素分析结果，对其中13项影响因素，进一步进行多因素非条件logistic回归分析，探讨VLBWI发生BPD的独立影响因素。

结果

①单因素分析结果显示：BPD组VLBWI母亲妊娠期高血压或子痫前期，以及剖宫产比例，均较非BPD组低，而产前出血比例，则较非BPD组高，并且差异均有统计学意义(P<0.05)；BPD组VLBWI胎龄较非BPD组小，出生体重较非BPD组轻；BPD组VLBWI出生后1 min及5 min Apgar评分≤7分所占比例、PS使用率、机械通气率及时间，以及新生儿呼吸窘迫综合征(NRDS)、动脉导管未闭(PDA)和脑室周-脑室内出血/脑室周围白质软化(PIVH/PVL)发生率，则均较非BPD组高或长，并且上述差异均有统计学意义(P<0.05)。②VLBWI发生BPD影响因素的多因素非条件logistic回归分析结果显示：胎龄<29.5周(OR＝3.876, 95%CI：1.260～11.924，P<0.05)，出生体重<1 300 g(OR＝3.983，95%CI：1.165～13.621，P<0.05)是VLBWI发生BPD的独立危险因素；机械通气时间<7 d(OR＝0.146，95%CI：0.050～0.424，P<0.05)是VLBWI是否发生BPD的独立保护因素。

结论

避免早产及合理的机械通气策略，可能降低VLBWI的BPD发生率。

关键词: 支气管肺发育不良, 危险因素, 婴儿，极低出生体重
Objective

To explorer the influencing factors of very low birth weight infants (VLBWI) with bronchopulmonary dysplasia (BPD).

Methods

A total of 163 VLBWI in neonatal intensive care unit of West China Second University Hospital, Sichuan University, from January to December 2015, were chosen as study subjects. They were divided into BPD group(n=57) and non BPD group (n=106) according to discharged diagnosis. Clinical data were analyzed retrospectively, and following factors were compared statistically to explore the influences on BPD in VLBWI. ① A total of 12 items of maternal prenatal conditions between 2 groups, including age, parity, primiparity, multifetation, regular prenatal examination, complications at delivery, delivery mode, etc.. ② A total of 14 items of neonatal conditions, including gestational age, birth weight, gender, 1 min and 5 min Apgar scores, postnatal usage of pulmonary surfactant (PS), usage rate and duration of mechanical ventilation and postnatal complications.etc.. Based on the results of existing studies, clinical experience and results of univariate analysis, multivariate unconditional logistic regression analysis was performed about the 13 factors with significant differences, in order to discuss independent impact factors about BPD in VLBWI.

Results

①Results of univariate analysis showed that: the ratio of hypertension or preeclampsia during pregnancy and caesarean section of maternal in BPD group were lower than those of non BPD group, but the ratio of antepartum hemorrhage was higher than that of non BPD group, and the differences were statistically significant (P<0.05). Gestational age and birth weight of VLBWI in BPD group were younger or lighter than those of non BPD group. Ratio of Apgar score≤7 scores of 1 min and 5 min after birth, usage rate of PS, usage rate and duration of mechanical ventilation, incidence rates of neonatal respiratory distress syndrome (NRDS), patent ductus arteriosus (PDA) and periventricular-intraventricular hemorrhage/periventricular leukomalacia (PIVH/PVL) of neonates in BPD group were all higher or longer than those of non BPD group, and the differences were statistically significant (P<0.05). ②Results of multivariate unconditional logistic regression analysis showed that: gestational age<29.5 weeks(OR=3.876, 95%CI: 1.260-11.924, P<0.05), birth weight<1 300 g (OR=3.983, 95%CI: 1.165-13.621, P<0.05) were independent risk factors about suffering BPD in VLBWI; duration of mechanical ventilation<7 d (OR=0.146, 95%CI: 0.050-0.424, P<0.05) was an independent protection factor about suffering BPD in VLBWI.

Conclusion

Avoiding premature delivery and proper mechanical ventilation strategy might reduce the incidence rate of BPD in VLBWI.

Key words: Bronchopulmonary dysplasia, Risk factors, Infant, very low birth weight
表1 2组极低出生体重儿母亲产前一般临床资料比较
组别 例数 年龄(岁，±s) 胎次[次，M(P25～P75)] 初产妇[例数(%)] 多胎妊娠[例数(%)] 规律产前检查[例数(%)] 妊娠期糖尿病[例数(%)]
BPD组 57 30.1±4.4 2.0(1.0～3.0) 19(33.3) 31(54.4) 48(84.2) 19(33.3)
非BPD组 106 30.4±5.1 2.0(1.0～3.0) 38(35.8) 48(45.3) 79(74.5) 25(23.6)
检验值 ? t＝－3.900 Z＝－0.316 χ2＝0.187 χ2＝1.230 χ2＝2.019 χ2＝1.787
P值 ? 0.697 0.752 0.665 0.325 0.172 0.181
组别 例数 妊娠期高血压或子痫前期[例数(%)] 产前出血[例数(%)] 胎膜早破[例数(%)] 产前使用糖皮质激素[例数(%)] 剖宫产[例数(%)] 产前合并感染[例数(%)]
BPD组 57 4(7.0) 22(38.6) 23(40.4) 44(77.2) 18(31.6) 45(79.0)
非BPD组 106 24(22.6) 16(15.1) 41(38.7) 67(63.2) 63(59.4) 73(68.9)
检验值 ? χ2＝6.360 χ2＝11.450 χ2＝0.043 χ2＝3.327 χ2＝11.510 χ2＝1.884
P值 ? 0.015 0.001 0.835 0.079 0.001 0.201
表2 2组极低出生体重儿一般临床资料比较
组别 例数 胎龄(周，±s) 出生体重(g，±s) 男性患儿[例数(%)] 出生后1 minApgar评分≤7分[例数(%)] 出生后5 minApgar评分≤7分[例数(%)] 使用PS[例数(%)] PS使用≥2次[例数(%)]
BPD组 57 28.9±1.0 1 132±168 30(52.6) 30(52.6) 12(21.1) 50(87.7) 4(7.0)
非BPD组 106 31.6±1.7 1 308±141 43(40.6) 29(27.4) 6(5.7) 37(34.9) 1(0.9)
检验值 ? t＝－12.810 t′＝－7.040 χ2＝2.182 χ2＝8.983 χ2＝8.440 χ2＝41.546 χ2＝4.600
P值 ? <0.001 <0.001 0.140 0.004 0.008 <0.001 0.051
组别 例数 机械通气[例数(%)] 机械通气时间(d，±s) NRDS[例数(%)] PDA[例数(%)] 肺出血[例数(%)] 新生儿坏死性小肠结肠炎[例数(%)] PIVH/PVL[例数(%)]
BPD组 57 57(100.0) 3.0±4.4 48(84.2) 46(80.7) 3(5.3) 1(1.8) 44(77.2)
非BPD组 106 62(58.5) 0.3±1.2 37(34.9) 69(65.1) 1(0.9) 6(5.7) 64(60.3)
检验值 ? χ2＝32.409 t′＝4.487 χ2＝36.110 χ2＝4.346 χ2＝2.890 χ2＝1.376 χ2＝4.688
P值 ? <0.001 <0.001 <0.001 0.043 0.123 0.423 0.037
表3 极低出生体重儿发生支气管肺发育不良影响因素的多因素非条件logistic回归分析的变量含义及赋值情况
解释变量/结局变量 变量名 赋值
BPD y y＝0表示未发生BPD，y＝1表示发生BPD
母亲妊娠期高血压疾病 x1 x1＝0表示未合并妊娠期高血压疾病，x1＝1表示合并妊娠期高血压疾病
母亲产前出血 x2 x2＝0表示未发生产前出血，x2＝1表示发生产前出血
剖宫产分娩 x3 x3＝0表示非剖宫产分娩，x3＝1表示剖宫产分娩
VLBWI胎龄 x4 x4＝0表示VLBWI胎龄≥29.5周，x4＝1表示VLBWI胎龄<29.5周
VLBWI出生体重 x5 x5＝0表示VLBWI出生体重≥1 300 g，x5＝1表示VLBWI出生体重<1 300 g
出生后1 min Apgar评分 x6 x6＝0表示出生后1 min Apgar评分>7分，x6＝1表示出生后1 min Apgar评分≤7分
出生后5 min Apgar评分 x7 x7＝0表示出生后5 min Apgar评分>7分，x7＝1表示出生后5 min Apgar评分≤7分
使用PS x8 x8＝0表示未使用PS，x8＝1表示使用PS
VLBWI机械通气 x9 x9＝0表示未使用机械通气，x9＝1表示使用机械通气
VLBWI机械通气时间 x10 x10＝0表示机械通气时间≥7 d，x10＝1表示机械通气时间<7 d
合并NRDS x11 x11＝0表示未合并NRDS，x11＝1表示合并NRDS
合并PDA x12 x12＝0表示未合并PDA，x12＝1表示合并PDA
合并PIVH/PVL x13 x13＝0表示未合并PIVH/PVL，x13＝1表示合并PIVH/PVL
表4 极低出生体重儿发生支气管肺发育不良影响因素的多因素非条件logistic回归分析
影响因素 B SE Wald值 P值 OR值 OR值95%CI
母亲妊娠期高血压疾病 －1.245 1.014 1.507 0.220 0.288 0.039～2.101
母亲产前出血 0.840 0.663 1.602 0.206 2.315 0.631～8.496
剖宫产分娩 －0.877 0.616 2.023 0.155 0.416 0.124～1.393
VLBWI胎龄 1.355 0.573 5.585 0.018 3.876 1.260～11.924
VLBWI出生体重 1.382 0.627 4.853 0.028 3.983 1.165～13.621
出生后1 min Apgar评分 0.110 0.646 0.029 0.864 1.117 0.315～3.957
出生后5 min Apgar评分 0.350 0.936 0.140 0.709 1.419 0.226～8.893
使用PS 17.332 4 569.510 0.000 0.997 3.366×107 0.000～0.000
VLBWI机械通气 31.299 6 475.981 0.000 0.996 3.916×1013 0.000～0.000
VLBWI机械通气时间 －1.927 0.546 12.453 <0.001 0.146 0.050～0.424
合并NRDS －16.580 4 569.510 0.000 0.997 0.000 0.000～0.000
合并PDA 0.573 0.632 0.822 0.365 1.773 0.514～6.119
合并PIVH/PVL 0.614 0.894 0.472 0.492 1.848 0.321～10.647
[1]
Islam JY, Keller RL, Aschner JL, et al. Understanding the short- and long-term respiratory outcomes of prematurity and bronchopulmonary dysplasia[J]. Am J Respir Crit Care Med, 2015, 192(2): 134-156.
[2]
Bolisetty S, Dhawan A, Abdel-Latif M, et al. Intraventricular hemorrhage and neurodevelopmental outcomes in extreme preterm infants[J]. Pediatrics, 2014, 133(1): 55-62.
[3]
常立文. 支气管肺发育不良∥邵肖梅，叶鸿瑁，丘小汕，主编. 实用新生儿学. 4版[M]. 北京：人民卫生出版社，2011: 416-422.
[4]
Pugni L, Pietrasanta C, Acaia B, et al. Chorioamnionitis and neonatal outcome in preterm infants: a clinical overview[J]. J Matern Fetal Neonatal Med, 2016, 29(9): 1525-1529.
[5]
Trembath A, Laughon MM. Predictors of bronchopulmonary dysplasia[J]. Clin Perinatol, 2012, 39(3): 585-601.
[6]
Gortner L, Misselwitz B, Milligan D, et al. Rates of bronchopulmonary dysplasia in very preterm neonates in Europe: results from the MOSAIC cohort[J]. Neonatology, 2011, 99(2): 112-117.
[7]
Madurga A, Mizíková I, Ruiz-Camp J, et al. Recent advances in late lung development and the pathogenesis of bronchopulmonary dysplasia[J]. Am J Physiol Lung Cell Mol Physiol, 2013, 305(12): L893-L905.
[8]
Furukawa S, Doi K, Furuta K, et al. The effect of placental abruption on the outcome of extremely premature infants[J]. J Matern Fetal Neonatal Med, 2015, 28(6): 705-708.
[9]
Hackney DN, Kuo K, Petersen RJ, et al. Determinants of the competing outcomes of intrauterine infection, abruption, or spontaneous preterm birth after preterm premature rupture of membranes[J]. J Matern Fetal Neonatal Med, 2016, 29(2): 258-263.
[10]
Keszler M, Sant′Anna G. Mechanical ventilation and bronchopulmonary dysplasia[J]. Clin Perinatol, 2015, 42(4): 781-796.
[11]
McEvoy CT, Jain L, Schmidt B, et al.Bronchopulmonary dysplasia: NHLBI workshop on the primary prevention of chronic lung diseases[J]. Ann Am Thorac Soc, 2014, 11(Suppl 3): S146-S153.
[12]
Shahzad T, Radajewski S, Chao CM, et al. Pathogenesis of bronchopulmonary dysplasia: when inflammation meets organ development[J]. Mol Cell Pediatr, 2016, 3(1): 23.
[13]
Melville JM, Moss TJ. The immune consequences of preterm birth[J]. Front Neurosci, 2013, 7: 79.
[14]
Carlo WA. Gentle ventilation: the new evidence from the SUPPORT, COIN, VON, CURPAP, Colombian Network, and Neocosur Network trials[J]. Early Hum Dev, 2012, 88(Suppl 2): S81-S83.
[15]
Stoll BJ, Hansen NI, Bell EF, et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012[J]. JAMA, 2015, 314(10): 1039-1051.
[16]
Glass HC, Costarino AT, Stayer SA, et al. Outcomes for extremely premature infants[J]. Anesth Analg, 2015, 120(6): 1337-1351
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