产妇与新生儿多维度因素对早产儿支气管肺发育不良风险及分级影响分析

Influences of multidimensional maternal and neonatal factors on risk and grading of severity of bronchopulmonary dysplasia in preterm infants

摘要

目的 分析产妇与新生儿多维度因素对早产儿支气管肺发育不良(BPD)的风险及严重程度分级的影响。方法 回顾性收集268例梅州市人民医院2021年1月-2024年6月收治的出生体重低于1500g、胎龄<32周的早产儿.根据患儿是否发生BPD分为BPD组(n=85)和无BPD组(n=183);其中85例BPD早产儿根据BPD严重程度分级标准分为Ⅰ度BPD组(n=42)和Ⅱ/Ⅲ度BPD组(n=43).比较组间的产妇、新生儿等因素的差异,并采用多因素Logistic回归方法分析BPD的发生及严重程度分级的影响因素。结果 胎龄、出生体重、窒息、喂养不耐受、肺炎、动脉导管未闭(PDA)、PDA药物治疗、新生儿呼吸窘迫综合征(RDS)、新生儿视网膜病变(ROP)、有创机械通气时长、无创通气时长、常压吸氧时长与是否患有BPD有关(t/χ²/Z值分别为3.763、5.387、20.889、4.663、5.381、20.634、5.869、7.380、15.779、-8.136、-7.860、-4.971,P<0.05);胎龄小(OR=1.369,95%CI:1.167~1.605)、体重轻(OR=1.015,95%CI:1.003~1.036)、常压吸氧时间长(OR=1.005,95%CI:1.002~1.007)、无创通气时间长(OR=1.004,95%CI:1.003~1.005)、有创机械通气时间长(OR=1.002,95%CI:1.001~1.003)是BPD的独立风险因素(P<0.05);胎龄、出生体重、喂养不耐受、使用地塞米松治疗、有创机械通气时长与BPD严重程度分级有关(t/χ²/Z值分别为2.024、2.696、4.344、9.660、-3.925,P<0.05);体重轻(OR=1.006,95%CI:1.002~1.010)、有创机械通气时间长(OR=1.014,95%CI:1.011~1.045)是BPD严重程度分级的独立风险因素(P<0.05)。结论 胎龄小、出生体重轻、常压吸氧时间长、无创通气时间长、有创机械通气时间长可致BPD风险增加;早产儿出生体重越轻、有创机械通气时间越长,发生Ⅱ/Ⅲ度BPD的几率越大,因此,对于胎龄小、低出生体重的早产儿,应首选无创通气,减少机械通气时长.

Abstract

Objective To investigate influences of multidimensional maternal and neonatal factors on risk and grading of severity of bronchopulmonary dysplasia (BPD) in preterm infants. Methods The clinical data of 268 preterm infants with birth weight less than 1500g and gestational age less than 32 weeks who admitted to Meizhou Municipal People's Hospital from January 2021 to June 2024 were retrospectively analyzed. According to presence or absence of BPD, the preterm infants were divided into two groups: BPD group (n=85) and non-BPD group (n=183). Of them, the preterm infants were further classified into mild BPD group (grade I of BPD, n=42) and moderate/severe BPD group (grades Ⅱ/Ⅲ of BPD, n=43) according to grading criteria for BDP severity. Maternal, neonatal and other variables were compared between the two groups. Multivariate Logistic regression analysis was used to analyze influencing factors for occurrence of BPD and grading of severity of BPD. Results Such factors as gestational age, birth weight, asphyxia, feeding intolerance, pneumonia, patent ductus arteriosus (PDA), pharmacotherapy for PDA, respiratory distress syndrome (RDS), retinopathy of prematurity (ROP), invasive mechanical ventilation duration, noninvasive mechanical ventilation duration and atmospheric oxygen therapy duration were significantly associated with development of BPD (t/χ ²/Z=3.763, 5.387, 20.889, 4.663, 5.381, 20.634, 5.869, 7.380, 15.779, -8.136, -7.860 and -4.971 respectively, P<0.05). Specifically, smaller gestational age (OR=1.369, 95%CI: 1.167-1.605), lower birth weight (OR=1.015, 95%CI: 1.003-1.036), extended normobaric oxygen therapy (OR=1.005, 95%CI: 1.002-1.007), prolonged noninvasive ventilation duration (OR=1.004, 95%CI: 1.003-1.005) and prolonged invasive mechanical ventilation (OR=1.002, 95%CI: 1.001-1.003) were identified as independent risk factors for BPD (P<0.05). Additionally, gestational age, birth weight, feeding intolerance, administration of dexamethasone, invasive mechanical ventilation duration were correlated with grading of severity of BPD (t/χ²/Z=2.024, 2.696, 4.344, 9.660 and -3.925 respectively, all P<0.05). Lower birth weight (OR=1.006, 95%CI: 1.002-1.010) and extended invasive mechanical ventilation duration (OR=1.014, 95%CI: 1.011-1.045) were both independent risk factors for grading of BPD severity (P<0.05). Conclusions Small gestational age, low birth weight, long duration of oxygen therapy under normal pressure, long duration of noninvasive ventilation, and long duration of invasive mechanical ventilation can increase the risk of BPD. The lighter the birth weight of preterm infants and the longer the duration of invasive mechanical ventilation, the higher the risk for developing grades Ⅱ/Ⅲ of BPD. Therefore, for those preterm infants with small gestational age and low birth weight, the duration of non-invasive ventilation should be preferred to choose, and the duration of invasive mechanical ventilation duration should be shortened.

关键词

产妇 / 新生儿 / 早产儿 / 支气管肺发育不良 / 风险 / 分级 / 多维度因素

Key words

parturient women / neonate / preterm infant / bronchopulmonary dysplasia / risk / grading / multidimensional factor

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基金资助

梅州市社会发展科技计划项目(201110152051300)