超低出生体重儿肺出血的临床特征及影响因素研究

Study on clinical characteristics and influencing factors of pulmonary hemorrhage in extremely low birth weight infants

摘要

目的 探讨超低出生体重儿(ELBWI)肺出血的临床特点及危险因素。方法 回顾性分析2019年8月至2023年8月收治于河南省人民医院新生儿科重症监护室的175例ELBWI的临床资料,根据住院期间是否发生肺出血,将其分为肺出血组(37例)与对照组(138例);将存活的145例患儿按是否发生肺出血,将其分为肺出血1组(22例)与对照1组(123例);收集并比较各组的临床资料,采用多因素Logistic回归分析ELBWI的危险因素。结果 在纳入的175例ELBWI中,肺出血发生率为21.14%,病死率为18.92%,肺出血发生日龄中位数为3(2,6)天.肺出血组的患儿出生体重明显低于对照组(t=-2.339),产房气管插管率明显高于对照组(χ²=4.414),产前糖皮质激素(ACS)使用率明显低于对照组(χ²=5.618),经比较差异均有统计学意义(P<0.05).肺出血组血小板计数(PLT)明显低于对照组(t=-4.269),而平均血小板体积(MPV)明显高于对照组(t=2.159),肺出血组使用血管活性药物、肺表面活性物质(PS)的分布均明显高于对照组(χ²值分别为5.942、5.456),经比较差异均有统计学意义(P<0.05).肺出血组Ⅲ~Ⅳ级呼吸窘迫综合征(RDS)、早发败血症(EOS)、重度支气管肺发育不良(BPD)的分布及死亡率均明显高于对照组,经比较差异均有统计学意义(χ²值分别为20.024、5.982、9.769、17.241,P<0.05).肺出血1组坏死性小肠结肠炎(NEC)(χ²=4.860)、胆汁淤积(χ²=5.523)、Ⅲ~Ⅳ度颅内出血(ICH)(χ²=4.689)的分布,以及住院时间(t=3.134)、用氧时间(t=3.298)、有创通气时间(t=4.353)均明显高于对照组,经比较差异均有统计学意义(P<0.05).多因素Logistic回归分析显示,使用ACS(OR=0.277,P<0.05)是ELBWI肺出血的保护因素,Ⅲ~Ⅳ级RDS(OR=3.236,P<0.05)、PLT减少是ELBWI肺出血的独立危险因素,PLT<100×10⁹/L的患儿发生肺出血的风险是PLT≥150×10⁹/L的12.477倍、PLT为100×10⁹/L~<150×10⁹/L的患儿发生肺出血的风险是PLT≥150×10⁹/L的3.087倍(P<0.05)。结论 合理使用ACS可有效地降低ELBWI肺出血的风险,Ⅲ~Ⅳ级RDS、PLT减少可增加肺出血的风险;发生肺出血的ELBWI有创通气及用氧时间延长,短期预后差.

Abstract

Objective To investigate the clinical characteristics and risk factors of pulmonary hemorrhage in extremely low birth weight infant (ELBWI). Methods A retrospective analysis was made on 175 cases of ELBWI admitted to Neonatal Pediatrics intensive Care Unit of Henan Provincial people's Hospital from August 2019 to August 2023. According to the occurrence of pulmonary hemorrhage during hospitalization, the patients were divided into pulmonary hemorrhage group (37 cases) and control group (138 cases). The 145 surviving children were divided into group 1 (22 cases) and control group 1 (123 cases) according to whether they had pulmonary hemorrhage. The clinical data of each group were collected and compared, and multivariate logistic regression was used to analyze the risk factors of ELBWI. Results Among the 175 patients with ELBWI, the incidence of pulmonary hemorrhage was 21.14%, the case fatality rate was 18.92%, and the median age of pulmonary hemorrhage was 3(2,6) days. The birth weight of the children in the pulmonary hemorrhage group was significantly lower than that in the control group (t=-2.339), the endotracheal intubation rate in the delivery room (χ²=4.414) was significantly higher than that in the control group, and the ACS utilization rate (χ²=5.618) was significantly lower than that in the control group, and the differences were statistically significant (P<0.05). The platelet count (PLT) in the pulmonary hemorrhage group was significantly lower than that in the control group (t=-4.269), while the mean platelet volume (MPV) was significantly higher than that in the control group (t=2.159), and the distribution of vasoactive drugs and PS in the pulmonary hemorrhage group was significantly higher than that in the control group (χ² values were 5.942 and 5.456, respectively), and the differences were statistically significant (P<0.05). The distribution and mortality of grade Ⅲ-Ⅳ RDS, EOS and severe BPD in the pulmonary hemorrhage group were significantly higher than those in the control group, and the differences were statistically significant (χ² values were 20.024, 5.982, 9.769 and 17.241, P<0.05, respectively). The distribution of NEC (χ²=4.860), cholestasis (χ²=5.523), Ⅲ-Ⅳ ICH (χ²=4.689), hospital stay (t=3.134), oxygen time (t=3.298) and invasive ventilation time (t=4.353) in the first group of pulmonary hemorrhage were significantly higher than those in the control group, and the differences were statistically significant (P<0.05). Multivariate Logistic regression analysis showed that the use of ACS (OR=0.277, P<0.05) was a protective factor for pulmonary hemorrhage in ELBWI, the reduction of grade Ⅲ-Ⅳ RDS (OR=3.236, P<0.05) and PLT were independent risk factors for pulmonary hemorrhage in ELBWI, and the risk of pulmonary hemorrhage in children with PLT<100×10⁹/L was 12.477 times that of PLT≥150×10⁹/L, and PLT was 100×10⁹/L. The risk of pulmonary hemorrhage in children with L~<150×10⁹/L was 3.087 times higher than that of PLT≥150×10⁹/L (P<0.05). Conclusions Rational application of ACS can effectively reduce the risk of pulmonary hemorrhage in ELBWI, and the reduction of grade Ⅲ-Ⅳ RDS and PLT can increase the risk of pulmonary hemorrhage. ELBWI with pulmonary hemorrhage is associated with prolonged invasive ventilation and oxygen use, and a poor short-term prognosis.

关键词

超低出生体重儿 / 肺出血 / 危险因素 / 早产儿

Key words

extremely low birth weight infant / pulmonary hemorrhage / risk factor / preterm infant

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