摘要
目的探讨极低出生体质量儿(VLBWI)并支气管肺发育不良(BPD)的危险因素及预防对策。方法回顾性分析应用呼吸机治疗且住院28d以上的VLBWI共56例。分析20余种高危因素与BPD发生的关系。结果BPD发生率为41.07%(23/56例),占使用机械通气VLBWI的17.04%(23/135例),占所有VLBWI的6.20%(23/371例)。BPD组FiO2、吸气峰压(PIP)、呼气末正压(PEEP)、平均呼吸道压(MAP)、上机日龄、产前应用地塞米松促肺成熟、生后应用肺表面活性物质(PS)等与对照组比较差异均无显著性意义(Pa>0.05),而胎龄≤30周、出生体质量≤1250g、上机次数>2次、并肺炎、肺出血、上机5d、痰培养阳性2次以上与对照组比较均有显著性差异(Pa<0.05);多因素Logistic回归分析显示,并肺炎、使用机械通气天数回归系数为0.952、0.144;OR值分别为2.591、1.154。结论缩短应用机械通气时间、防止及减少肺部感染,尤其是严重感染是预防VLBWI发生BPD的重要措施。
Objective To investigate the risk factors, prevention and treatment of bronchopulmonary dysplasia（BPD） in very low birth weight infants（VLBWI）. Methods A retrospective study was performed in VLBWI with mechanical ventilation and hospitalized more than 28 days. More than 20 factors were analyzed as the risk factors of BPD. Results The overall incidence of BPD in VLBWI with mechanical ventilation and hospitalized more than 28 days was 41.07% （23/56） ,and 17.04% （23/135）in those VLBWI who received mechanical ventilation, and 6.20% （ 23/371 ） in those infants whose birth weight ≤ 1 500 g. FiO2, peak inspiratory pressure （ PIP）, positive end - expiratory pressure （PEEP）, mean airway pressure（ MAP）, the days of starting mechanical ventilation, maternal prenatal administration of dexamethasone and usage of pulmonary surfactant to newborn had no significant differences between BPD and control groups （ Pα 〉 0.05 ）. But there were significant differences in gestational age less than or equal to 30 weeks, birth weight less than 1 250 g, times of mechanical ventilation treatment （ 32 times ）, pulmonary infection, pneumorrhagia, prolonged mechanical ventilation （ ≥ 5 days） and positive culture of the lower respiration secretion more than 2 times （ Pα 〈 0.05 ） ; Multivariate logistic analysis revealed that pulmonary infection with regression coefficient 0. 952, odd ratio （OR）2. 591 ;the days prolonged mechanical ventilation with regression coefficient 0. 144 ,OR 1. 154. Conclusion Shortening the duration of mechanical ventilation to prevent pneumonia, particularly serious pnenumonia, is important in preventing BPD.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2007年第2期109-110,118,共3页
Journal of Applied Clinical Pediatrics
