作　　者： (吴晨）; (邓春）;

机构地区： 重庆医科大学附属儿童医院新生儿科、儿童发育疾病研究教育部重点实验室、儿童发育重大疾病国家国际科技合作基地、儿科学重庆市重点实验室,重庆400014

出　　处： 《重庆医科大学学报》 2017年第8期1016-1022,共7页

摘　　要： 目的:探讨新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)并发支气管肺发育不良(bronchopulmonary dysplasia,BPD)的高危因素,为BPD的防治提供临床依据,从而降低BPD的发病率。方法:选取2008年1月至2014年12月重庆医科大学新生儿诊治中心收治住院时间大于28 d的NRDS患儿共287例,根据有无并发BPD分为BPD组及非BPD组,对2组的临床资料进行回顾性分析。结果:287例NRDS患儿中131例发生BPD,为BPD组,未发生BPD的患儿共156例,为非BPD组。单因素分析结果显示:胎龄、出生体质量、住院天数、母亲年龄、剖宫产、肺表面活性物质(pulmonary surfactant,PS)使用次数≥2次、PS剂量、痰培养阳性、反复机械通气、呼吸机模式、吸氧浓度FiO2、机械通气时间、总用氧时间、动脉导管未闭(patent ductus arteriosus,PDA)、呼吸机相关性肺炎、肺动脉高压(pulmonary hypertension,PH)患病率、临床治愈、放弃/死亡率、G-杆菌在2组比较中差异有统计学意义(P<0.05),而BPD组的Apgar1分钟、妊娠期并发症、PS使用率、使用PS的类型、首次PS使用时间、入院前3天血气分析结果、合并新生儿坏死性小肠结肠炎(NEC)、肺气漏、败血症、早产儿视网膜病变(retinopathy of prematurity,ROP)、颅内出血、肺出血等则与非BPD组差异无统计学意义(P>0.05)。多因素logistic回归显示高出生体质量、剖宫产为NRDS并发BPD的独立保护因素,而痰培养阳性率高、反复机械通气、长时间用氧、肺动脉高压为NRDS并发BPD的独立危险因素。结论:及时行剖宫产、避免低出生体重儿、反复上机、长时间氧疗及肺动脉高压为减少BPD发生的最重要措施。 Objective：To identify the risk factors for bronchopulmonary dysplasia（BPD）in neonatal respiratory distress syndrome（NRDS）. Methods：Data from 287 neonates with RDS who were hospitalized over 28 days were analyzed respectively. Results：Of the287 neonates,131 developed BPD. In univariate analysis,gestational age,birth weight,hospitalization duration,maternal age,cesarean section,the times of pulmonary surfactant（≥2 times）,the dose of pulmonary surfactant,the positive rate of sputum cultures,repeated mechanical ventilation,the mode of mechanical ventilation,the inhaled oxygen volume concentration,the duration of mechanical ventilation,the duration of oxygen,ventilator-associated pneumonia,pulmonary hypertension,patent ductus arteriosus（PDA）,the survival rate and the mortality,gran negative bacillus were all associated with an increase in the incidence of BPD（P〈0.05）. No significant differences was found in the first minute of Apgar score,the hospitalization time,the fetal distress,gestational complications,the rate of pulmonary surfactant,the time of pulmonary surfactant,the first blood gas analysis scores after birth,combined with neonatal necrotizing enterocolitis（NEC）,air leak,septicemia,retinopathy of prematurity（ROP）,intracranial hemorrhage,pneumorrhagia between the two groups（P〉0.05）. Multivariate logistic regression model showed that the high birth weight,cesarean section were protecting factors and the the positive rate of sputum cultures,repeated mechanical ventilation,the duration of oxygen and pulmonary hypertension were risk factors for BPD. Conclusion：Shortening the duration of oxygen and preventing the pulmonary hypertension are key methods to reduce BPD in neonates with RDS.

关 键 词： 新生儿呼吸窘迫征 支气管肺发育不良 新生儿 高危因素