低出生体重儿支气管肺发育不良的临床分析

发布时间：2018-01-31 01:03

本文关键词： 支气管肺发育不良低出生体重儿高危因素　出处：《重庆医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的：探讨影响低出生体重儿（Lowbirthweightinfant,LBWI）支气管肺发育不良发病及其严重程度的高危因素，为BPD的预防和治疗提供意见。方法：对重庆医科大学附属儿童医院新生儿重症监护室（Neonatalintensivecareunit,NICU）自2010年1月1日至2011年12月31日收治的体重＜2500g的1932例新生儿进行回顾性分析，其中生后持续用氧≥28d者50例，即支气管肺发育不良（Bronchopulmonarydysplasia,BPD）组；生后28d未用氧者1882例，即非BPD组。（1）将低出生体重儿按产重＜1000g，1000-1249g，1250-1499g，，1500-1749g，1750-1999g，2000-2249g，2250-2499g进行分组，计算各不同产重组BPD的患病率；（2）BPD组有9例因入院日龄过大、资料不全剔除，从非BPD组按产重随机选取41例，作为对照组，对两组患儿的临床资料进行对比分析；并对两组患儿生后3天内、7天内、10天内的总液体量、热卡摄入以及体重增长的速度进行对比研究。（3）根据患儿胎龄及不同胎龄生后持续用氧情况将BPD组分为轻度和中重度，比较两组临床资料。临床资料结果均采用计量或计数资料表示，计量资料首先检查正态性，若满足正态分布采取T检验，若不满足正态分布则采取非参数检验法；计数资料采用卡方检验（若出现理论频数＜1，则采用fisher精确概率法）比较两组资料之间的差异；Logistic回归分析找出BPD发病及病情分级程度的主要影响因素。结果：本院产重＜1000g，1000-1249g，1250-1499g，1500-1749g，1750-1999g，2000-2249g，2250-2499g的早产儿支气管肺发育不良的患病率分别为：10.34%、16.28%、4.97%、2.77%、1.52%、1.20%、0.72%，BPD的患病率总体随着产重的增加明显降低，单因素卡方检验分析结果显示:新生儿呼吸窘迫综合征（Respiratorydistresssyndrome,RDS）、呼吸衰竭、呼吸暂停、肺出血、危重病例等级、早产儿HB＜128.5g/L、机械通气、呼吸机持续时间＞7天、PaO2/FiO2＜300以及动脉导管未闭使用这10个因素在BPD组和非BPD组有显著差异。多因素Logistic回归向后步近法分析结果显示，血红蛋白（Hemoglobin,HB）＜128.5g/L、呼吸衰竭、呼吸暂停、动脉导管未闭(Patentductusarteriosus,PDA)为BPD发生的独立高危因素。BPD组与非BPD组患儿生后3天、7天、10天总液体量摄入、7-10日龄至出院前体重增长速度以及维生素A摄入量组间比较无显著的差异，而BPD组患儿生后3天、7天、10天总热卡摄入及住院期间平均HB较对照组明显降低。41例病例中轻度支气管肺发育不良17例，中重度24例。孕周＜32周是唯一对BPD病情严重程度有统计学差异的指标（P=0.024）。结论：我院低出生体重儿支气管肺发育不良的患病率为2.59%，患病率和体重呈负相关，呼吸衰竭、呼吸暂停、HB＜128.5g/L、PDA是BPD发生的独立高危因素，BPD组总能量摄入明显低于非BPD组。孕周＜32周是制约BPD发病严重程度的高危因素。
[Abstract]:Objective: to investigate the risk factors affecting the incidence and severity of bronchopulmonary dysplasia in low birthweight infants (LBWI). Provide advice on prevention and treatment of BPD. Methods: Neonatrical intensive care unit (NICU) of the Children's Hospital affiliated to Chongqing Medical University was used. From January 1st 2010 to December 31st 2011, 1 932 newborns weighing less than 2500g were analyzed retrospectively. Among them, 50 cases were treated with oxygen for more than 28 days after birth, that is, bronchopulmonary dysplasia (BPD) group. After 28 days of birth, 1 882 cases (non-#en0# group) were treated with low birth weight infants according to birth weight < 1000g / 1000-1249g / 1250-1499g. 1500-1749g / L 1750-1999g / 2000 2249g / 2250-2499g were grouped to calculate the prevalence rate of recombinant BPD in different production. Nine cases of bpd were selected randomly from non-#en0# group according to birth weight because of excessive age of admission and incomplete removal of data. The clinical data of the two groups were compared and analyzed. The total liquid volume within 7 days and 10 days after birth was measured in both groups. A comparative study of hot calorie intake and the rate of weight gain. 3) the BPD components were divided into mild and moderate severe groups according to their gestational age and continuous oxygen use after birth at different gestational ages. Two groups of clinical data were compared. The results of clinical data were expressed by metrological or counting data. The measured data were first examined for normality, and T test was adopted if normal distribution was satisfied. If the normal distribution is not satisfied, the nonparametric test method is adopted. The difference between the two groups of data was compared by chi-square test (if theoretical frequency < 1, fisher accurate probability method). Logistic regression analysis found out the main factors influencing the incidence and severity of BPD. Results: the weight of production in our hospital was less than 1000g / 1000-1249g / 1250-1499g / 1500-1749g / 1750-1999g / 2000-2249g. The prevalence of bronchopulmonary dysplasia in preterm infants of 2250-2499g was 10. 34% and 16. 28%, respectively. The prevalence of bpd decreased with the increase of birth weight. The results of univariate chi-square test showed that neonatal respiratory distress syndrome (RDS), respiratory failure and apnea. Pulmonary hemorrhage, critical case grade, HB < 128.5 g / L, mechanical ventilation, ventilator duration > 7 days. PaO2/FiO2 < 300 and the use of patent ductus arteriosus were significantly different between BPD group and non-#en2# group. Multivariate Logistic regression analysis showed that. . Hemoglobin B < 128.5 g / L, respiratory failure, apnea, patent ductus arteriosus. PDAA was an independent risk factor for the occurrence of BPD. The total liquid intake of bpd group and non BPD group was 7 days and 10 days after birth. There was no significant difference in body weight growth rate and vitamin A intake between 7-10 days old and pre-discharge group, while in BPD group there was no significant difference between 3 days and 7 days after birth. Total calorie intake and average HB during hospitalization were significantly lower in 10 days than in the control group. 17 cases were mild bronchopulmonary dysplasia. There were 24 moderate and severe cases. Gestational age less than 32 weeks was the only index with significant difference in severity of BPD. Conclusion: the prevalence of bronchopulmonary dysplasia in low birth weight infants was 2.59. The prevalence rate was negatively correlated with body weight, respiratory failure, apnea HB < 128.5 g / L. PDA was an independent risk factor for the occurrence of BPD. The total energy intake of bpd group was significantly lower than that of non-#en2# group, and the gestational age less than 32 weeks was the high risk factor to restrict the severity of BPD.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R722

【参考文献】