作　　者： (曹孟宸）; (李娟）; (孙伟）;

机构地区： 中国医科大学附属盛京医院第二新生儿科,沈阳110004

出　　处： 《中国小儿急救医学》 2017年第8期570-575,共6页

摘　　要： 目的探讨极低及超低出生体重（出生体重≤1200g）早产儿肺出血的影响因素及预后。方法回顾性分析2010年1月至2015年12月于中国医科大学附属盛京医院第二新生儿科住院、出生体重≤1200g、住院期间发生肺出血的极低及超低出生体重儿临床资料，同期住院、相同体重范围非肺出血早产儿作为对照组。比较两组母孕期及新生儿期特点，多元回归分析探讨肺出血影响因素，了解肺出血新生儿的近期预后。结果肺出血新生儿（肺出血组）71例，对照组364例。肺出血发生于3d以内者57例（占80．3％），肺出血组胎龄（28．2±1．7）周、出生体重（936±192）g，均明显低于对照组[（29．5±2．1）周，（1033±134）g，t分别为4．776、-5．145，P〈0．01]。肺出血组呼吸窘迫综合征（RDS）（76．1％）、肺表面活性物质治疗（76．1％，其中≥2次使用率9．9％）、动脉导管未闭（PDA）（66．2％）比例均明显高于对照组[41．2％、30．8％（4．1％）和38．7％，x^2值分别为33．457、28．970（4．074）和32．798，P〈0．05]。肺出血组产前类固醇激素治疗率（21．1％）亦明显低于对照组（41．2％，x^2=10．177，P〈0．01）。多因素Logistic逐步回归分析显示，RDS（OR=3．739，95％CI1．383—10．113，P〈0．05）、PDA（OR=2．206，95％CI1．205-4．093，P〈0．05）及5minApgar评分〈7（OR=2．851，95％CI1．191—6．828）是肺出血的独立危险因素；出生体重大（OR=0．998，95％C10．996-1．000，P〈0．05）及母孕期应用激素（OR=0．432，95％C10．22±0．834，P〈0．05）是肺出血的保护因素。肺出血组颅内出血、早产儿视网膜病及重度支气管肺发育不良发生率（16．9％、12．7％及18．3％）明显高于对照组（5．8％、4．4％及2．2％,X2值分别为36．824、7．520及33．568，P〈0．01）。肺出血组病死率（49．3％）亦明显高于对照� Objective To explore the risk factors and outcomes associated with pulmonary hemor- rhage in very low and extremely low birth weight infants. Methods Retrospective analysis were performed to predict risk factors for pulmonary hemorrhage in very low and extremely low birth weight infants （birth weight less than 1 200 g） admitted to NICU of Sheng±ing Hospital from Jan. 2010 to Dec. 2015. Infants at similar birth weight without pulmonary hemorrhage were as controls. We compared the characteristics of both maternal and infants. Multivariable Logistic regression models were derived to predict pulmonary hemorrhage. Short outcomes of the infants were assessed. Results Of the 435 neonates,71 developed pulmonary hemorrhage （pulmonary hemorrhage group） ,364 were as controls （control group）. Gestational age[ （28.2 ± 1.7 ）week ] , birth weight [ （936 ± 192）g ] in pulmonary hemorrhage group were significantly lower than those in control group[ （29. 5 ±2. 1 ）week, （1 033 ± 134）g,t =4. 776,5. 145 ,P 〈0. 01 1. Neonatal respiratory dis- tress syndrome（RDS） （76. 1% ） ,pulmonary surfactant （PS）use（PS use≥2 courses） [76. 1% （9. 9% ） ] ,patent ductus arteriosus （PDA） （66. 2% ）were significantly higher than those in control group[41.2% ,30. 8% （4. 1% ） ,38.7% ;x^2 = 33.457,28. 970 （4. 074 ）, 32. 798, P 〈 0. 05 ]. Antenatal corticosteroids utility ratio （21.1%）was lower than that in the control group （41.2% ;t = 10. 177 ,P 〈 0. 001 ）. Multiple factors Logis- tic stepwise regression analysis showed that RDS （OR = 3. 739,95% CI 1. 383 - 10. 113, P 〈 0. 05 ）, PDA （ OR = 2. 206,95 % CI 1. 205 - 4. 093, P 〈 0. 05 ）, and 5 minutes Apgar score 〈 7 （ OR = 2. 851,95 % CI 1.191 - 6. 828） were independent risk factors of pulmonary hemorrhage, and higher birth weight （ OR = 0. 998, 95% CI 0. 996 - 1. 000 ,P 〈 0. 05 ） and the use of antenatal corticosteroids （ OR = 0. 432,95% CI 0. 224 - 0. 834, P 〈 0. 05 ） were the protection factors

关 键 词： 新生儿肺出血 极低出生体重儿 超低出生体重儿 影响因素