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极低出生体重儿支气管肺发育不良的高危因素及防治
作者:方广东  贾贝贝  陈长春  姜善雨 
单位:南京医科大学附属无锡妇幼保健院 新生儿科, 江苏 无锡 214002
关键词:极低出生体重儿 支气管肺发育不良 危险因素 防治策略 
分类号:R722.1
出版年·卷·期(页码):2020·39·第四期(430-435)
摘要:

目的:探讨极低出生体重儿(VLBWI)支气管肺发育不良(BPD)的危险因素,提出有效的防治措施。方法:选取2013年1月至2017年12月在本院住院的130例有BPD的VLBWI作为BPD组,非BPD组选择同期住院的另外120例VLBWI。比较两组VLBWI的性别,胎龄,出生体重,是否应用机械通气,是否使用肺泡表面活性物质、肾上腺皮质激素等药物,是否存在感染,是否输血,是否发生动脉导管未关闭、呼吸暂停及新生儿呼吸窘迫综合征(NRDS)等合并症,探讨VLBWI BPD的危险因素,并提出有效的防治策略。结果:Logistic回归分析提示,男性、胎龄小、低出生体重、机械通气、发生NRDS、并发呼吸暂停为VLBWI BPD的高危因素。结论:减少机械通气、预防早产和低出生体重、应用兴奋呼吸中枢药物、预防NRDS及呼吸暂停能减少VLBWI BPD的发生。

Objective: To investigate high risk factors of very low birth weight infants with bronchopulmonary dysplasia and put forward effective prevention strategies.Methods: Totally 130 very low birth weight infants with bronchopulmonary dysplasia and 120 very low birth weight infants without bronchopulmonary dysplasia in our hospital were recruited from January, 2013 to December, 2017. Gender, gestational age, birth weight, the use of mechanical ventilation, the use of medicine including pulmonary surfactant and adrenocortical hormone,infection,blood transfusion, patent ductus arteriosus, apnea, neonatal respiratory distress syndrome and others were collected to analyze high risk factors of bronchopulmonary dysplasia, and providing effective prevention strategies. Results: Logistic regression analysis showed that male, small gestational age, low birth weight, mechanical ventilation, apnea and neonatal respiratory distress syndrome were high risk factors of very low birth weight infants with bronchopulmonary dysplasia. Conclusion: Reducing the use of mechanical ventilation, preventing premature delivery and low birth weight, usage of respiratory stimulants, and preventing apnea and neonatal respiratory distress syndrome can reduce the incidence of very low birth weight infants with bronchopulmonary dysplasia.

参考文献:

[1] 邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].5版.北京:人民卫生出版社,2019:596-601.
[2] JOBE A H,BANCALARI E.Bronchopulmonary dysplasia[J].Am J Respir Crit Care Med,2001,163(7):1723-1729.
[3] 尹燕丹,祁媛媛,洪达,等.早产儿支气管肺发育不良危险因素及2岁时随访结局[J].中国循证儿科杂志,2016,11(2):113-117.
[4] SILVA L V,ARAÚJO L B,VMGO A.Assessment of the neuropsychomotor development in the first year of life of premature infants with and without bronchopulmonary dysplasia[J].Rev Bras Ter Intensiva,2018,30(2):174-180.
[5] STEVENSON D K,VERTER J,FANAROFF A A,et al.Sex differences in outcomes of very low birthweight infants:the newborn male disadvantage[J].Arch Dis Child Fetal Neonatal Ed,2000,83(3):F182-185.
[6] FARSTAD T,BRATLID D,MEDBØ S,et al.Bronchopulmonary dysplasia-prevalence,severity and predictive factors in a national cohort of extremely premature infants[J].Acta Paediatr,2011,100(1):53-58.
[7] COARFA C,ZHANG Y,MAITY S,et al.Sexual dimorphism of the pulmonary transcriptome in neonatal hyperoxic lung injury:identification of angiogenesis as a key pathway[J].Am J Physiol Lung Cell Mol Physiol,2017,313(6):L991-L1005.
[8] KONG X,XU F,WU R,et al.Neonatal mortality and morbidity among infants between 24 to 31 complete weeks:a multicenter survey in China from 2013 to 2014[J].BMC Pediatr,2016,16(1):174.
[9] 王笑,徐艳,王军.极低、超低出生体重儿存活情况及住院并发症分析[J].现代医学,2020,39(1):82-87.
[10] 莫艳,陈玉君,韦秋芬,等.极低出生体重早产儿支气管肺发育不良高危因素分析[J/OL].中华妇幼临床医学杂志(电子版),2019,15(3):320-327.
[11] 江苏省新生儿重症监护病房母乳质量改进临床研究协作组.多中心回顾性分析极低及超低出生体重儿支气管肺发育不良的临床特点及高危因素[J].中华儿科杂志,2019,57(1):33-39.
[12] 张霄,张海涛,吕勇,等.不同维持剂量枸橼酸咖啡因治疗极低出生体重早产儿呼吸暂停的前瞻性随机对照研究[J].中国当代儿科杂志,2019,21(6):558-561.
[13] DREYFUSS D,SAUMON G.Ventilator-induced lung injury:lessons from experimental studies[J].Am J Respir Crit Care Med,1998,157(1):294-323.
[14] KESZLER M,SANT'ANNA G.Mechanical ventilation and bronchopulmonary dysplasia[J].Clin Perinatol,2015,42(4):781-796.
[15] BADER D,KUGELMAN A,BOYKO V,et al.Risk factors and estimation tool for death among extremely premature infants:a national study[J].Pediatrics,2010,125(4):696-703.
[16] 阚清,杨洋,邱洁,等.超低/极低出生体质量儿223例临床回顾分析[J].东南大学学报(医学版),2016,35(5):713-718.
[17] 潘静,陈名武,倪文泉,等.肺表面活性物质联合布地奈德预防极低出生体重儿支气管肺发育不良的疗效观察[J].中国当代儿科杂志,2017,19(2):137-141.
[18] YEH T F,CHEN C M,WU S Y,et al.Intratracheal Administration of Budesonide/Surfactant to Prevent Bronchopulmonary Dysplasia[J].Am J Respir Crit Care Med,2016,193(1):86-95.
[19] KRIBS A,ROLL C,GÖPEL W, et al. Nonintubated Surfactant Application vs Conventional Therapy in Extremely Preterm Infants:A Randomized Clinical Trial[J].JAMA Pediatr,2015,169(8):723-730.
[20] KIRPALANI H,RATCLIFFE S J,KESZLER M,et al.Effect of Sustained Inflations vs Intermittent Positive Pressure Ventilation on Bronchopulmonary Dysplasia or Death Among Extremely Preterm Infants:The SAIL Randomized Clinical Trial[J].JAMA,2019,321(12):1165-1175.
[21] SCHMÖLZER G M,KUMAR M,PICHLER G,et al.Non-invasive versus invasive respiratory support in preterm infants at birth:systematic review and meta-analysis[J].BMJ,2013,347(10):f5980.
[22] 陈萌萌,温晓红,黄金华,等.布地奈德联合咖啡因预防早产儿支气管肺发育不良的疗效研究[J].中国儿童保健杂志,2019,27(10):1124-1127.
[23] 封云,程锐,赵莉,等.早期或晚期使用枸橼酸咖啡因防治极低出生体重儿呼吸暂停的临床分析[J].中国当代儿科杂志,2018,21(12):979-984.
[24] JEFFERIES A L.Postnatal corticosteroids to treat or prevent chronic lung disease in preterm infants[J].Paediatr Child Health,2012,17(10):573-574.
[25] 刘敬,邱如新,高月乔.肺脏超声在早产儿支气管肺发育不良诊断中的应用[J].中国实用儿科杂志,2020,35(2):97-100.
[26] 王慧杰,徐艳,王军.TGF-β1与BMP对早产儿支气管肺发育不良早期预测作用[J].临床儿科杂志,2019,37(6):405-408.
[27] FIKE C D,SUMMAR M,ASCHNER J L.L-citrulline provides a novel strategy for treating chronic pulmonary hypertension in newborn infants[J].Acta Paediatr,2014,103(10):1019-1026.
[28] 包蕾,史源.间充质干细胞移植治疗新生儿支气管肺发育不良:机遇与挑战[J].中国当代儿科杂志,2019,21(7):619-623.

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