作　　者： (姚丽平）; (韦秋芬）; (李燕）; (沈开颜）; (闭宏娟）; (许靖）; (谭伟）; (经连芳）;

机构地区： 广西壮族自治区妇幼保健院新生儿科, 南宁,530003

出　　处： 《中国新生儿科杂志》

摘　　要： 目的 探讨极/超低出生体重早产儿支气管肺发育不良(bronchopulmonary dysplasia,BPD)3岁内随访结局.方法 选取2012年1～12月我院新生儿重症监护室收治的住院28 d以上的极/超低出生体重早产儿,根据氧依赖(＞21％)是否超过28 d分为BPD组和非BPD组,随访患儿1岁内、～2岁和～3岁时支气管炎、肺炎、喘息发作次数和住院次数;1岁时检测肺功能.分别采用独立样本t检验、秩和检验和x2检验比较两组患儿的临床情况.结果 共纳入72例极/超低出生体重早产儿,其中BPD组34例,非BPD组38例.BPD组胎龄、出生体重、应用INSURE技术比例均低于非BPD组,男性、新生儿呼吸窘迫综合征、动脉导管未闭、宫内感染性肺炎、机械通气、医院感染、吸氧浓度＞40％的比例均高于非BPD组,住院时间长于非BPD组,差异有统计学意义(P＜0.05).BPD组1岁内、～2岁和～3岁时支气管炎发生次数分别为55、38、18例次,喘息分别为27、22、11例次,均高于非BPD组,差异有统计学意义(P＜0.05);两组肺炎发生率及再入院率差异无统计学意义(P＞0.05).BPD组较非BPD组呼吸频率和潮气呼气峰流速增加,潮气量、呼气达峰时间和呼气达峰容积减少,差异有统计学意义(P＜0.05).结论 BPD常发生于胎龄小于32周的早产儿,其导致的婴幼儿肺功能损害主要表现为小气道阻塞性改变,患儿3岁内支气管炎、喘息发生率均增高. Objective To study the risk factors and prognosis of very/extremely low birth weight preterm (VLBW/ELBW) infants with bronchopulmonary dysplasia (BPD) during the first three years of life.Method From January 1st to December 31st,2012,a retrospective study was conducted on the VLBW/ELBW preterm infants with ＞ 28 days of hospitalization in the NICU of our hospital.The infants were assigned into BPD group (FiO2 ＞ 21％) and non-BPD group depending on the oxygen requirement on the 28th day after birth.The incidences of bronchitis,pneumonia,wheezing and re-hospitalization during the first three years of life were analyzed.The pulmonary function tests were performed at one-year-age.Independent-sapmles t test,Kruskal-wallis test and x2 test were used to compare the results between the two groups.Result A total of 72 patients were enrolled into this study.34 patients in the BPD group and 38 in the non-BPD group.The gestational age,birth weight and the use of INSURE technique of BPD group were significantly lower than non-BPD group,while the duration of hospital stays were longer than non-BPD group (P ＜0.05).The ratio of male,neonatal respiratory distress syndrome (RDS),patent ductus arteriosus (PDA),intrauterine infection,mechanical ventilation,nosocomial infection and the inhalation of high concentrations of oxygen were significantly higher in BPD group than non-BPD group (P ＜ 0.05).Incidences of bronchitis and wheezing during 0 ～ 1,1 ～ 2 and 2 ～ 3 years of age in the BPD were significantly higher than non-BPD group,separately.No significant differences existed in the incidences of pneumonia and re-hospitalization between the two groups.Pulmonary function test showed that the respiratory rate (RR) and peak tidal expiratory flow in the BPD group were significantly higher than non-BPD group,while the tidal volume,peak expiratory time and peak expiratory volume were significantly lower in BPD group than non-BPD group (P ＜ 0.05).Conclusion BPD often occurs in preterm infants with gestational age less than 32 weeks.It may cause impaired pulmonary function,characterized by obstruction in small airway,and increases the risk of bronchitis and wheezing during the first three year of life.

分 类 号： [Z1]