超低出生体重儿大量肺出血高危因素与临床特征分析

发布时间：2018-03-23 14:50

本文选题：肺出血　切入点：高危因素　出处：《中国当代儿科杂志》2017年01期

【摘要】：目的探讨超低出生体重儿(ELBW)大量肺出血(MPH)的常见高危因素,并对其临床特点进行分析。方法 211例ELBW患儿分为MPH组(35例)和无肺出血的对照组(176例)。比较两组临床特征、病死率及并发症的差异,并采用多因素logistic回归分析探讨MPH的高危因素。结果 MPH组患儿胎龄、出生体重及5 min Apgar评分均低于对照组(P0.05),而新生儿呼吸窘迫综合征(RDS)、动脉导管未闭(PDA)、早发型败血症(EOS)及颅内出血的发生率、肺表面活性物质(PS)使用率、病死率均明显高于对照组(P0.01)。多因素logistic回归分析显示,5 min Apgar评分是MPH发生的保护因素(OR=0.666,P0.05),而合并PDA和EOS是MPH发生的危险因素(分别OR=3.717、3.276,均P0.05)。在正常出院的患儿中,MPH组的辅助通气时间长于对照组,呼吸机相关性肺炎(VAP)的发生率高于对照组(P0.05)。结论较高的5 min Apgar评分可降低ELBW患儿MPH发生的危险,而合并PDA和EOS可增加ELBW患儿MPH发生的危险。MPH患儿机械通气时间更长,病死率及VAP、颅内出血的发生率更高。
[Abstract]:Objective to investigate the common risk factors of massive pulmonary hemorrhage (MPH) in ultra-low birth weight infants (ELBW) and to analyze its clinical characteristics. Methods 211 cases of ELBW were divided into MPH group (n = 35) and control group (n = 176). The risk factors of MPH were analyzed by multivariate logistic regression analysis. Results the gestational age of children with MPH was analyzed. The birth weight and 5 min Apgar score were lower than those in the control group (P 0.05). However, the incidence of neonatal respiratory distress syndrome (RDS), patent ductus arteriosus (PDA), early septicemia and intracranial hemorrhage (ICH), and the rate of pulmonary surfactant utilization were significantly lower than those in the control group. Multivariate logistic regression analysis showed that 5 min Apgar score was the protective factor of MPH, while PDA and EOS were the risk factors of MPH (OR3.7173.276, all P 0.05). The time of auxiliary ventilation was longer than that of control group. The incidence of ventilator-associated pneumonia (VAP) was higher than that of control group (P0.050.Conclusion higher score of 5 min Apgar can reduce the risk of MPH in ELBW children, and the combination of PDA and EOS can increase the risk of MPH in ELBW children. The mechanical ventilation time of MPH children is longer. Mortality and VAP, the incidence of intracranial hemorrhage is higher.
【作者单位】：中国医科大学附属盛京医院新生儿内科;

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