摘要
目的:分析并总结本新生儿重症监护室(neonatal intensive care unit,NICU)极早和超早产儿的救治现状及支气管肺发育不良(bronchopulmonary dysplasia,BPD)发病情况。方法:回顾性分析2018年1月—2020年12月南京医科大学附属儿童医院新生儿医疗中心收治的胎龄<32周且出院日龄≥28 d共547例早产儿的临床资料,按临床诊断分为BPD组(n=126)和非BPD组(n=421),综合比较两组早产儿的情况,并纵向分析、总结3年的临床资料及BPD情况。结果:BPD组胎龄为(28.57±1.49)周,胎龄<28周的超早产儿占31.7%,而非BPD组胎龄为(30.05±1.39)周,超早产儿仅占8.1%(P<0.05)。BPD组出生体重(1132.18±251.25)g,<1000 g的超低出生体重儿占28.6%,而非BPD组出生体重(1384.47±267.44)g,超低出生体重儿仅占6.4%(P<0.05)。BPD组5 min Apgar评分≤7分、产房复苏率均升高(P<0.05)。非BPD组使用肺表面活性物质(pulmonary surfactant,PS)者第1次使用剂量显著大于BPD组(P<0.05),≥2次使用率低于BPD组(P<0.01)。BPD组有创及无创通气比例、通气持续时间及肺出血发病率均显著升高(P均<0.001),住院时间及总费用均高于非BPD组(P<0.05)。纵向分析,3年BPD总发病率为23.0%,2019年最高(28.8%),2018年最低(15.3%),差异有统计学意义(P<0.05);有创机械通气比例、超早产儿及超低出生体重儿比例均无显著差异(P>0.05),但2018年超低出生体重儿的平均体重显著高于其他年份(P<0.05)。结论:应加强对超早产儿及超低出生体重儿早期病情的监测及跟踪,重视PS的早期规范化应用,以进一步减少BPD,改善临床预后。
Objective:To analyze and summarize the treatment status and the incidence of bronchopulmonary dysplasia(BPD)in very preterm infants(VPI)and extremely preterm infants(EPI)in the latest 3 years.Methods:A retrospective analysis was performed in 547 premature infants,with gestational age less than 32 weeks and survival time≥28 days,who were admitted to Neonatal Medical Center of Children’s Hospital of Nanjing Medical University from January 2018 to December 2020.According to clinical diagnosis,they were divided into BPD group(n=126)and non-BPD group(n=421).The two groups were compared comprehensively,and the clinical data and incidence of BPD among the latest 3 years were compared and summarized.Results:The gestational age of the BPD group was 28.57±1.49 weeks,and the EPI with gestational age less than 28 weeks accounted for 31.7%,while that of the non-BPD group was 30.05±1.39 weeks,and the EPI was only 8.1%(P<0.05).The birth weight of BPD group was 1132.18±251.25 g,and the extremely low birth weight(ELBW)infants with birth weight<1000 g accounted for 28.6%,while that of non-BPD group was1384.47±267.44 g,and ELBW infants only accounted for 6.4%(P<0.05).The proportion of 5 min Apgar score≤7 and resuscitation in the delivery room were significantly higher in BPD group(P<0.05).The first dose of the pulmonary surfactant was significantly higher(P<0.05)and the rate of usage times≥2 times was lower(P<0.01)in the non-BPD group.The the proportion of invasive mechanical ventilation and non-invasive ventilation,duration of ventilation and incidence of pulmonary hemorrhage were significantly increased in BPD group(P<0.001).The length of hospitalization was significantly longer and total cost was higher in BPD group(P<0.05).Longitudinal analysis showed the total incidence of BPD was 23.0%in three years,while it was 28.8%in 2019 and 15.3%in 2018(P<0.05),there were no significant differences in the proportion of invasive mechanical ventilation,EPI and ELBW(P>0.05),but the ELBW in 2018 was significantly higher than other years(P<0.05).Conclusion:It is necessary to monitor and track the early situation of EPI and ELBW,and pay more attention to the standardized application of PS in the early stage,to further reduce BPD and improve the prognosis greatly.
作者
沈仙
陈许
卢刻羽
朱雯
陆亚东
程锐
莫绪明
SHEN Xian;CHEN Xu;LU Keyu;ZHU Wen;LU Yadong;CHENG Rui;MO Xuming(Department of Neonatology,Children’s Hospital of Nanjing Medical University,Nanjing 210008,China;Depa6rtment of Cardiothoracic Surgery Children’s Hospital of Nanjing Medical University,Nanjing 210008,China)
出处
《南京医科大学学报（自然科学版）》
CAS
CSCD
北大核心
2022年第10期1440-1445,共6页
Journal of Nanjing Medical University(Natural Sciences)
基金
南京市医学科技发展项目(YKK17157)。
关键词
支气管肺发育不良
超早产儿
极早产儿
超低出生体重儿
bronchopulmonary dysplasia
extremely preterm infant
very preterm infant
extremely low birth weight
