产重低于1500g的新生儿支气管肺发育不良风险预测模型的建立及效能分析
发布时间：2019-03-06 10:00
【摘要】：目的:建立早期预测产重低于1500g的新生儿发生支气管肺发育不良(Bronchopulmonary dysplasia,BPD)的风险预测模型,为预防BPD发生。及改善BPD预后提供有效指导。方法:对重庆医科大学附属儿童医院新生儿科从2014年1月1日至2016年5月31日收治的产重低于1500g的311例新生儿进行回顾性分析。出生后28天仍需用氧者86例诊断为BPD组,生后28天时无需用氧者225例为非BPD组。对BPD组及对照组临床特点进行分析比较。临床特点包括以下方面:母亲因素:母亲年龄,子痫前期,妊娠糖尿病(Gestational diabetes mellitus,GDM),绒毛膜羊膜炎,胎膜早破(Premature rupture of membranes,PROM),羊水过少,双胎或多胎妊娠,产前激素的使用,宫内生长受限(Intrauterine growth restriction,IUGR),宫内窘迫;新生儿相关因素:生产方式(剖宫产),新生儿窒息,产房复苏,性别(男性),胎龄,产重,插管,新生儿呼吸窘迫综合征(Neonatal respiratory distress syndrome,NRDS),动脉导管未闭(Patent ductus arteriosus,PDA),肺动脉高压(Pulmonary hypertension,PH),颅内出血(intraventricular hemorrhage,IVH),痰培养阳性,败血症,肺出血,生后3天内液体总量均值、新生儿贫血、低钙血症、低血糖症。对以上因素进行单因素分析。(3)对有统计学意义的临床特点进行多因素logistic回归,找出影响bpd发生的独立危险因素,并建立风险评估模型。运用roc曲线评估模型效能。(4)对2016年6月1日-2016年12月31日61例入住nicu患儿进行前瞻性评分。与生后28天情况比较,评估预测模型的效能。结果:产重1000g、1000g-1200g、1201g-1499g死亡率分别为17.4%,8.8%,4.8%。随着体重的增加,新生儿死亡率明显降低。单因素分析结果显示:生产方式(剖宫产),新生儿窒息,产房复苏,性别(男),胎龄,产重,nrds,pda,ph,ivh,痰培养阳性,败血症,肺出血,低钙血症这14个因素在两组之间有显著差异。而母亲的年龄,子痫前期,gdm,绒毛羊膜炎,prom,双胎或多胎妊娠,产前激素的使用,iugr,宫内窘迫,生后3天内液体总量均值,新生儿贫血,低血糖症无统计学差异。进一步行多因素logistic回归分析结果:新生儿窒息,性别(男性),痰培养阳性,败血症,肺动脉高压为导致bpd发生的独立危险因素。对2016年6月1日-2016年12月31日收入nicu患儿即检验组在生后7天内进行评分。预测模型进行效能检验,预测的敏感度为91%,特异度为74%,阳性预测值为83%,阴性预测值为74%。说明该评分系统有较好的预测效能。结论:该风险预测模型能够较准确地筛查出极低出生体重儿中可能发生bpd的患儿,从而指导用药,尽早采取干预bpd发生的措施。
[Abstract]:Aim: to establish an early predictive model for the risk of bronchopulmonary dysplasia (Bronchopulmonary dysplasia,BPD) in neonates with birth weight less than 1500g in order to prevent the occurrence of BPD. And improve the prognosis of BPD to provide effective guidance. Methods: 311 neonates whose birth weight was less than 1500g from January 1, 2014 to May 31, 2016 were analyzed retrospectively in the Department of Neonatal Pediatrics, affiliated Children's Hospital of Chongqing Medical University. 86 patients still needed oxygen at 28 days after birth were diagnosed as BPD group, while those who did not need oxygen at 28 days after birth were diagnosed as non-BPD group. The clinical characteristics of BPD group and control group were analyzed and compared. Clinical features include maternal factors: maternal age, preeclampsia, gestational diabetes mellitus (Gestational diabetes mellitus,GDM), chorioamnionitis, premature rupture of membranes (Premature rupture of membranes,PROM), oligohydramnios, twin or multiple pregnancies, Prenatal hormone use, intrauterine growth restriction (Intrauterine growth restriction,IUGR (IUGR), intrauterine distress; Neonatal related factors: mode of production (cesarean section), neonatal asphyxia, antepartum resuscitation, sex (male), gestational age, birth weight, intubation, neonatal respiratory distress syndrome (Neonatal respiratory distress syndrome,NRDS), patent ductus arteriosus (Patent ductus arteriosus, PDA), pulmonary hypertension (Pulmonary hypertension,PH), intracranial hemorrhage (intraventricular hemorrhage,IVH), sputum culture positive, septicemia, pulmonary hemorrhage, mean fluid volume within 3 days after birth, neonatal anemia, hypocalcemia, hypoglycemia. The above factors were analyzed by univariate analysis. (3) Multivariate logistic regression was performed to identify the independent risk factors affecting the occurrence of bpd, and a risk assessment model was established. The efficacy of the model was evaluated by roc curve. (4) 61 children admitted to nicu from June 1, 2016 to December 31, 2016 were evaluated prospectively. Compared with 28 days after birth, the effectiveness of the prediction model was evaluated. Results: the mortality rates were 17.4%, 8.8% and 4.8% respectively for 1 000 g, 1 000 g / kg, 1 201 g / kg and 1 201 g / kg, respectively. Neonatal mortality decreased significantly with weight gain. Univariate analysis showed that: mode of production (cesarean section), neonatal asphyxia, antepartum resuscitation, sex (male), gestational age, birth weight, positive nrds,pda,ph,ivh, sputum culture, septicemia, pulmonary hemorrhage, The 14 factors of hypocalcemia were significantly different between the two groups. However, there was no significant difference in maternal age, preeclampsia, gdm, chorioamnionitis, prom, twin or multiple pregnancy, prenatal hormone use, iugr, intrauterine distress, mean fluid volume within 3 days after birth, neonatal anemia and hypoglycemia. Further multivariate logistic regression analysis showed that neonatal asphyxia, sex (male), positive sputum culture, septicemia and pulmonary hypertension were independent risk factors for bpd. The children with nicu from June 1, 2016 to December 31, 2016 were evaluated within 7 days after birth. The sensitivity, specificity, positive predictive value and negative predictive value of the prediction model were 91%, 74%, 83% and 74%, respectively. This indicates that the scoring system has a good prediction efficiency. Conclusion: the risk prediction model can accurately screen children with bpd in very low birth weight infants, so as to guide the use of drugs and take measures to intervene the occurrence of bpd as soon as possible.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R722.1
[Abstract]:Aim: to establish an early predictive model for the risk of bronchopulmonary dysplasia (Bronchopulmonary dysplasia,BPD) in neonates with birth weight less than 1500g in order to prevent the occurrence of BPD. And improve the prognosis of BPD to provide effective guidance. Methods: 311 neonates whose birth weight was less than 1500g from January 1, 2014 to May 31, 2016 were analyzed retrospectively in the Department of Neonatal Pediatrics, affiliated Children's Hospital of Chongqing Medical University. 86 patients still needed oxygen at 28 days after birth were diagnosed as BPD group, while those who did not need oxygen at 28 days after birth were diagnosed as non-BPD group. The clinical characteristics of BPD group and control group were analyzed and compared. Clinical features include maternal factors: maternal age, preeclampsia, gestational diabetes mellitus (Gestational diabetes mellitus,GDM), chorioamnionitis, premature rupture of membranes (Premature rupture of membranes,PROM), oligohydramnios, twin or multiple pregnancies, Prenatal hormone use, intrauterine growth restriction (Intrauterine growth restriction,IUGR (IUGR), intrauterine distress; Neonatal related factors: mode of production (cesarean section), neonatal asphyxia, antepartum resuscitation, sex (male), gestational age, birth weight, intubation, neonatal respiratory distress syndrome (Neonatal respiratory distress syndrome,NRDS), patent ductus arteriosus (Patent ductus arteriosus, PDA), pulmonary hypertension (Pulmonary hypertension,PH), intracranial hemorrhage (intraventricular hemorrhage,IVH), sputum culture positive, septicemia, pulmonary hemorrhage, mean fluid volume within 3 days after birth, neonatal anemia, hypocalcemia, hypoglycemia. The above factors were analyzed by univariate analysis. (3) Multivariate logistic regression was performed to identify the independent risk factors affecting the occurrence of bpd, and a risk assessment model was established. The efficacy of the model was evaluated by roc curve. (4) 61 children admitted to nicu from June 1, 2016 to December 31, 2016 were evaluated prospectively. Compared with 28 days after birth, the effectiveness of the prediction model was evaluated. Results: the mortality rates were 17.4%, 8.8% and 4.8% respectively for 1 000 g, 1 000 g / kg, 1 201 g / kg and 1 201 g / kg, respectively. Neonatal mortality decreased significantly with weight gain. Univariate analysis showed that: mode of production (cesarean section), neonatal asphyxia, antepartum resuscitation, sex (male), gestational age, birth weight, positive nrds,pda,ph,ivh, sputum culture, septicemia, pulmonary hemorrhage, The 14 factors of hypocalcemia were significantly different between the two groups. However, there was no significant difference in maternal age, preeclampsia, gdm, chorioamnionitis, prom, twin or multiple pregnancy, prenatal hormone use, iugr, intrauterine distress, mean fluid volume within 3 days after birth, neonatal anemia and hypoglycemia. Further multivariate logistic regression analysis showed that neonatal asphyxia, sex (male), positive sputum culture, septicemia and pulmonary hypertension were independent risk factors for bpd. The children with nicu from June 1, 2016 to December 31, 2016 were evaluated within 7 days after birth. The sensitivity, specificity, positive predictive value and negative predictive value of the prediction model were 91%, 74%, 83% and 74%, respectively. This indicates that the scoring system has a good prediction efficiency. Conclusion: the risk prediction model can accurately screen children with bpd in very low birth weight infants, so as to guide the use of drugs and take measures to intervene the occurrence of bpd as soon as possible.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R722.1
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