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中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2024, Vol. 20 ›› Issue (02) : 209 -215. doi: 10.3877/cma.j.issn.1673-5250.2024.02.012

论著

早产小于胎龄儿发生支气管肺发育不良的危险因素及预后分析
郭立珍1, 范天群2, 张欣凯1, 蒋韵红1, 金蓉3, 刘冬云3,†()   
  1. 1. 青岛大学，青岛　266000；青岛大学附属医院儿童医学中心，青岛　266000
    2. 临沂市人民医院儿科，临沂　276000
    3. 青岛大学附属医院儿童医学中心，青岛　266000
  • 收稿日期:2024-02-01 修回日期:2024-03-05 出版日期:2024-04-01
  • 通信作者: 刘冬云

Risk factors and prognosis analysis of bronchopulmonary dysplasia in preterm small for gestational age infants

Lizhen Guo1, Tianqun Fan2, Xinkai Zhang1, Yunhong Jiang1, Rong Jin3, Dongyun Liu3,†()   

  1. 1. Qingdao University, Qingdao 266000, Shandong Province, China; Children′s Medical Center of the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
    2. Department of Pediatrics, Linyi People′s Hospital, Linyi 276000, Shandong Province, China
    3. Children′s Medical Center of the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
  • Received:2024-02-01 Revised:2024-03-05 Published:2024-04-01
  • Corresponding author: Dongyun Liu
  • Supported by:
    Medical and Health Technology Development Plan of Shandong Province(2017WSB26008)
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引用本文：

郭立珍, 范天群, 张欣凯, 蒋韵红, 金蓉, 刘冬云. 早产小于胎龄儿发生支气管肺发育不良的危险因素及预后分析[J]. 中华妇幼临床医学杂志(电子版), 2024, 20(02): 209-215.

Lizhen Guo, Tianqun Fan, Xinkai Zhang, Yunhong Jiang, Rong Jin, Dongyun Liu. Risk factors and prognosis analysis of bronchopulmonary dysplasia in preterm small for gestational age infants[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(02): 209-215.

目的

探讨早产小于胎龄(SGA)儿发生支气管肺发育不良(BPD)的影响因素及预后。

方法

选择2019年1月至2021年12月于青岛大学附属医院新生儿重症监护病房(NICU)住院治疗的92例早产(出生胎龄为24～32周)SGA儿为研究对象。采用回顾性队列研究方法，根据矫正胎龄36周时是否诊断为BPD，将其分为BPD组(n＝38)和无BPD组(n＝54)。对2组早产SGA儿临床资料、住院期内治疗情况及BPD相关并发症发生率等，采用χ2检验、独立样本t检验及Mann-Whitney U检验进行统计学比较；并采用多因素非条件logistic回归分析法，对影响早产SGA儿发生BPD的独立影响因素进行分析。本研究经本院医学伦理委员会批准(审批文号：QYFY WZLL 28257)，所有受试儿监护人对诊疗知情同意并签署临床研究知情同意书。

结果

①BPD组早产SGA儿生后1个月体重、出生身长及头围、生后1 min及5 min Apgar评分均低于、短于、小于无BPD组；有创机械通气、无创机械通气、吸氧及住院时间，以及肺表面活性剂(PS)使用率均长于、高于无BPD组，并且差异均有统计学意义(P<0.01)。②多因素非条件logistic回归分析结果显示，早产SGA儿无创机械通气时间长(OR＝1.180，95%CI: 1.064～1.308，P＝0.002)，生后吸氧时间长(OR＝1.295，95%CI: 1.126～1.488，P<0.001)，均为导致早产SGA儿发生BPD的独立危险因素。③BPD组早产SGA儿感染性肺炎、晚发败血症、有血流动力学意义的动脉导管未闭(hsPDA)及早产儿视网膜病变(ROP)发生率，均高于无BPD组，并且差异均有统计学意义(P<0.05)。

结论

对于早产SGA儿，临床应适宜掌握无创机械通气及吸氧时间，可降低其BPD及相关并发症发生率。

关键词: 支气管肺发育不良, 婴儿，小于胎龄, 危险因素, 早产儿视网膜病, 动脉导管未闭, 婴儿，早产
Objective

To investigate influencing factors and prognosis of bronchopulmonary dysplasia (BPD) in preterm small for gestational age (SGA) infants.

Methods

A total of 92 preterm (gestational age of 24-32 weeks) SGA infants who were hospitalized in Neonatal Intensive Care Unit (NICU) of Affiliated Hospital of Qingdao University from January 2019 to December 2021 were selected as study subjects. Using a retrospective cohort study method, they were divided into BPD group (n=38) and BPD-free group (n=54) according to whether BPD was diagnosed at 36 weeks′ corrected gestational age or not. The clinical data, treatment and BPD related complications of preterm SGA infants between two groups were statistically compared by chi-square test, independent samples t test and Mann-Whitney U test. Multivariate unconditional logistic regression analysis was used to analyze the independent influencing factors of BPD in preterm SGA infants. This study was approved by the Medical Ethics Committee of our hospital (Approval No. QYFY WZLL 28257), and the guardians of all subjects gave informed consent to diagnosis and treatment and signed an informed consent form for this clinical study.

Results

① The body weight at 1 month after birth, birth length and head circumference, Apgar score at 1 min and 5 min after birth of preterm SGA infants in BPD group were lower, shorter and smaller than those in BPD-free group, while invasive mechanical ventilation, noninvasive mechanical ventilation, oxygen inhalation and hospitalization time, and the utilization rate of pulmonary surfactant (PS) were longer, higher than those in BPD-free group, and all the differences were statistically significant (P<0.01). ② The results of multivariate unconditional logistic regression analysis showed that the long duration of non-invasive mechanical ventilation (OR=1.180, 95%CI: 1.064-1.308, P=0.002) and the long duration of oxygen inhalation after birth (OR=1.295, 95%CI: 1.126-1.488, P<0.001) were independent risk factors for BPD in preterm SGA infants. ③ The incidences of pneumonia, late-onset sepsis, hemodynamically significant patent ductus arteriosus (hsPDA) and retinopathy of prematurity (ROP) in the BPD group were higher than those in the BPD-free group, and the differences were statistically significant (P<0.05).

Conclusion

For preterm SGA infants, the timing of non-invasive mechanical ventilation and oxygen inhalation should be appropriately controlled to reduce the incidence of BPD and related complications.

Key words: Bronchopulmonary dysplasia, Infant, small for gestational age, Risk factors, Retinopathy of prematurity, Ductus arteriosus, patent, Infant, premature
表1 2组早产SGA儿临床资料比较
组别 例数 母亲
自然受孕[例数(%)] 顺产[例数(%)] 产前感染[例数(%)] 年龄(岁，±s) 妊娠期高血压疾病[例数(%)] 妊娠期糖尿病[例数(%)] 产前使用激素[例数(%)]
BPD组 38 37(97.4) 4(10.5) 13(34.2) 32.8±4.1 24(63.2) 6(15.8) 37(97.4)
无BPD组 54 53(98.1) 0(0) 18(33.3) 32.8±4.8 35(64.8) 11(20.4) 47(87.0)
统计量   －a －a χ2＝0.01 t＝0.03 χ2＝0.03 χ2＝0.31 －a
P值   >0.999 0.026 0.930 0.979 0.870 0.577 0.134
组别 例数 生后1个月体重(g，±s) 男性[例数(%)] 单胎[例数(%)] 出生身长(cm，±s) 出生头围(cm，±s) 生后1 min Apgar评分[分，M(Q1，Q3)] 生后5 min Apgar评分[分，M(Q1，Q3)]
BPD组 38 1 332±279 24(63.2) 26(68.4) 34.5±2.8 25.4±2.2 6.5(5.0，8.0) 8.0(7.0，9.0)
无BPD组 54 1 549±255 29(53.7) 47(87.0) 36.5±3.0 26.9±2.0 8.0(7.0，9.0) 9.0(8.0，10.0)
统计量   t＝3.87 χ2＝0.82 χ2＝4.72 t＝3.34 t＝3.28 Z＝4.32 Z＝3.61
P值   <0.001 0.366 0.030 0.001 0.001 <0.001 <0.001
组别 例数 出生时血小板计数[×109/L，M(Q1，Q3)] 出生时Hb水平[g/L，M(Q1，Q3)] 有创机械通气时间[d，M(Q1，Q3)] 无创机械通气时间[d，M(Q1，Q3)] 面罩/鼻导管/箱内吸氧时间[d，M(Q1，Q3)] 开奶时间[d，M(Q1，Q3)] 静脉营养时间[d，M(Q1，Q3)]
BPD组 38 180(154，196) 171(160，182) 0(0，4) 35.5(18.0，52.0) 24(8，35) 1(1，2) 28.5(22.0，41.0)
无BPD组 54 189(156，218) 178(163，191) 0(0，0) 10.0(6.0，20.0) 0(0，4) 1(1，2) 25.0(18.0，32.0)
统计量   Z＝0.96 Z＝1.69 Z＝3.94 Z＝5.32 Z＝6.36 Z＝0.71 Z＝2.03
P值   0.339 0.092 <0.001 <0.001 <0.001 0.478 0.021
组别 例数 全胃肠营养时间[d，M(Q1，Q3)] 输血[例数(%)] 使用PS[例数(%)] PS剂量[mg，M(Q1，Q3)] 住院时间[d，M(Q1，Q3)] 父亲年龄[岁，M(Q1，Q3)]
BPD组 38 29.5(23.0，42.0) 32(84.2) 18(47.4) 0(0，220) 75.5(61.0，97.0) 33(30，39)
无BPD组 54 26.0(19.0，33.0) 34(63.0) 11(20.4) 0(0，0) 54.0(47.0，65.0) 33(30，37)
统计量   Z＝2.19 χ2＝4.97 χ2＝7.53 Z＝2.53 Z＝4.93 Z＝0.24
P值   0.029 0.026 0.006 0.011 <0.001 0.814
表2 早产SGA儿发生BPD的多因素非条件logistic回归分析结果
影响因素 B SE Wald值 P值 OR值 OR值95%CI
生后1个月体重(连续变量) 0.003 0.004 0.477 0.490 1.003 0.995～1.011
1 min Apgar评分(连续变量) 0.099 0.518 0.037 0.848 1.104 0.400～3.049
5 min Apgar评分(连续变量) －0.089 0.619 0.020 0.886 0.915 0.272～3.081
出生身长(连续变量) 0.119 0.222 0.287 0.592 1.126 0.729～1.740
出生头围(连续变量) 0.367 0.348 1.112 0.292 1.443 0.730～2.853
有创机械通气(连续变量) 0.825 0.545 2.288 0.130 2.281 0.784～6.642
无创机械通气(连续变量) 0.165 0.053 9.850 0.002 1.180 1.064～1.308
面罩/鼻导管/箱内吸氧(连续变量) 0.258 0.071 13.175 <0.001 1.295 1.126～1.488
住院时间(连续变量) 0.005 0.067 0.005 0.946 1.005 0.881～1.145
使用PS(vs未使用) －1.760 1.515 1.348 0.246 0.172 0.009～3.355
常数项 －25.596 16.523 2.400 0.121 <0.001 －
表3 2组早产SGA儿并发症发生率比较[例数(%)]
组别 例数 感染性肺炎 贫血 新生儿低血糖 肠外营养相关性胆汁淤积症 晚发败血症 NRDS
BPD组 38 30(78.9) 38(100.0) 2(5.3) 7(18.4) 13(34.2) 38(100.0)
无BPD组 54 14(25.9) 54(100.0) 4(7.4) 12(22.2) 6(11.1) 53(98.1)
χ2值   25.13 －a －a 0.20 7.26 －a
P值   <0.001 >0.999 >0.999 0.657 0.007 >0.999
组别 例数 hsPDA 肺动脉高压 ROP NEC 喂养不耐受
BPD组 38 23(60.5) 8(21.1) 14(36.8) 2(5.3) 5(13.2)
无BPD组 54 17(31.5) 4(7.4) 7(13.0) 3(5.6) 12(22.2)
χ2值   7.66 2.56 7.22 －a 1.22
P值   0.006 0.110 0.007 >0.999 0.270
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