超未成熟儿支气管肺发育不良临床特点、治疗及预后分析
|
摘要
目的探讨超未成熟儿支气管肺发育不良(BPD)的临床特点、治疗及预后。方法回顾分析2014年8月至2017年8月住院的超未成熟儿(胎龄<28周的早产儿)的临床资料,根据超未成熟儿出生28天时有无吸氧及BPD临床分度,分为非BPD组,轻度、中度以及重度BPD组,探讨其临床特点及治疗和预后。结果入选205例超未成熟儿,平均胎龄(26.2±1.2)周,平均出生体质量(0.87±0.19)kg;放弃治疗46例、死亡15例,最终出院144例(70.3%)。不同程度BPD组之间动脉导管未闭(PDA)比例、感染率的差异均有统计学意义(P<0. 01),中、重度BPD组的PDA发生率较高,重度BPD组的感染率较高。不同程度BPD组之间的用氧时间、住院时间、住院费用以及糖皮质激素治疗率、肺部后遗症发生率的差异均有统计学意义(P<0.01),随着BPD病情加重,用氧时间、住院时间和住院费用均逐渐增加;中重度患儿均使用糖皮质激素,且肺部后遗症发生率较高。结论 BPD仍是影响超未成熟儿预后的重要合并症,早期预防及系统治疗可减轻严重后遗症。
Objective To explore the clinical characteristics, treatment and prognosis of bronchopulmonary dysplasia(BPD) in extremely preterm infants. Method The clinical data of extremely preterm infants with gestational age < 28 weeks hospitalized between August 2014 and August 2017 were retrospectively analyzed. According to oxygen inhalation and BPD clinical grading at 28 days after the birth, extremely preterm infants were divided into non-BPD group, mild, moderate and severe BPD groups, and their clinical characteristics, treatment and prognosis were discussed. Results A total of 205 extremely preterm infants were enrolled, with an average gestational age of(26.2±1.2) weeks and an average birth weight of(0.87±0.19) kg. Among them, 46 infants were gave up treatment, 15 died, and 144(70.3%) were discharged eventually. There were statistically significant differences in the rates of patent ductus arteriosus(PDA) and infection among groups with different degrees of BPD(P<0.01). The incidence of PDA was higher in the moderate and severe BPD groups, and the infection rate was higher in the severe BPD group. The oxygen use time, length of stay, hospitalization cost, glucocorticoid treatment rate and incidence of pulmonary sequelae among groups with different degrees of BPD were significantly different(P<0.01). With oxygen use time, length of hospital stay and hospitalization cost increased gradually over the aggravation of BPD. Glucocorticoids were used in all moderate and severe children, and the incidence of pulmonary sequelae was higher. Conclusion BPD still is an important complication affecting the prognosis of extremely preterm infants. Early prevention and systematic treatment can alleviate severe sequela.
Objective To explore the clinical characteristics, treatment and prognosis of bronchopulmonary dysplasia(BPD) in extremely preterm infants. Method The clinical data of extremely preterm infants with gestational age < 28 weeks hospitalized between August 2014 and August 2017 were retrospectively analyzed. According to oxygen inhalation and BPD clinical grading at 28 days after the birth, extremely preterm infants were divided into non-BPD group, mild, moderate and severe BPD groups, and their clinical characteristics, treatment and prognosis were discussed. Results A total of 205 extremely preterm infants were enrolled, with an average gestational age of(26.2±1.2) weeks and an average birth weight of(0.87±0.19) kg. Among them, 46 infants were gave up treatment, 15 died, and 144(70.3%) were discharged eventually. There were statistically significant differences in the rates of patent ductus arteriosus(PDA) and infection among groups with different degrees of BPD(P<0.01). The incidence of PDA was higher in the moderate and severe BPD groups, and the infection rate was higher in the severe BPD group. The oxygen use time, length of stay, hospitalization cost, glucocorticoid treatment rate and incidence of pulmonary sequelae among groups with different degrees of BPD were significantly different(P<0.01). With oxygen use time, length of hospital stay and hospitalization cost increased gradually over the aggravation of BPD. Glucocorticoids were used in all moderate and severe children, and the incidence of pulmonary sequelae was higher. Conclusion BPD still is an important complication affecting the prognosis of extremely preterm infants. Early prevention and systematic treatment can alleviate severe sequela.
引文
[1]Beeton ML,Maxwell NC,Davies PL,et al.Role of pulmonary infection in the development of chronic lung disease of prematurity[J].Eur Respir,2011,37(6):1424-1430.
[2]陈超,袁琳.早产儿支气管肺发育不良的病因及危险因素[J].中国实用儿科杂志,2014,29(1):5-7.
[3]Jobe AH,Bancalari E.Bronchopulmonary dysplasia[J].Am J Respir Crit Care Med,2001,163(7):1723-1729.
[4]邵肖梅,叶鸿瑁,丘小汕,等.实用新生儿学[M].4版.北京:人民卫生出版社,2011.
[5]De Buyst J,Rakza T,Pennaforte T,et al.Hemodynamic effects of fluid restriction in preterm infants with significant patent ductus arteriosus[J].J Paediatr,2012,161(3):404-408.
[6]McEvoy CT,Aschner JL.The Natural history of bronchopulmonary dysplasia:the case for primary prevention[M].Clin Perinatol,2015,42(4):911-931.
[7]Northway WH Jr,Rosan RC,Porter DY.Pulmonary disease following respiratory therapy of hyalinemembrane disease Bronchopulmonary dysplasia[J].N Engl J Med,1967,276(7):357-368.
[8]McEvoy CT,Jain L,Schmidt B,et al.Bronchopulmonary dysplasia:NHLBI Workshop on the Primary Prevention of Chronic Lung Diseases[J].Ann Am Thorac Soc,2014,11(Suppl 3):S178.
[9]Barbara J,Stoll BJ,Hansen NI,et al.Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network[J].Pediatrics,2010,126(3):443-456.
[10]The Canadian Neonatal Network.Annual Report 2009[R/OL].http://www.canadianneonatalnetwork.org/Portal/LinkClick.aspx?fileticket=QleibWI8d10%3d&tabid=69[2018-03-21].2010.
[11]胡亚美,江载芳.诸福棠实用儿科学[M].7版.北京:人民卫生出版社,2012.
[12]Kallapur SG,Kramer BW,Nitsos I,et al.Pulmonary and systemic inflammatory responses to intra-amniotic IL-1alpha in fetal sheep[J].Am J Physiol Lung Cell Mol Physiol,2011,301(3):285-295.
[13]Abdel-Hady H,Nasef N,Shabaan AE,et al.Patent ductus arteriosus in preterm infants:do we have the right answers?[J].Biomed Res Int,2013,2013(4):676192.
[14]Evans N.Preterm patent ductus arteriosus:should we treat it?[J].J Paediatr Child Health,2012,48(9):753-758.
[15]Bhat R,Salas AA,Foster C,et al.Prospective analysis of pulmonary hypertension in extremely low birth weight infants[J].Pediatrics,2012,129(3):682-689.
[16]Slaughter JL,Pakrashi T,Jones DE,et al.Echocardiographic detection of pulmonary hypertension in extremely low birth weight infants with bronchopulmonary dysplasia requiring prolonged positive pressure ventilation[J].J Perinatol,2011,31(10):635-640.
[17]Mestan KK,Check J,Minturn L,et al.Placental pathologic changes of maternal vascular underperfusion in bronchopulmonary dysplasia and pulmonary hypertension[J].Placenta,2014,35(8):570-574.
[18]Slaughter JL,Pakrashi T,Jones DE.Echocardiographic detection of pulmonary hypertension in extremely low birth weight infants with bronchopulmonary dysplasia requiring prolonged positive pressure ventilation[J].Perinatol,2011,31(10):635.
[19]Khemani E,McElhinney DB,Rhein L,et al.Pulmonary artery hypertension in formerly premature infants with bronchopulmonary dysplasia:clinical features and outcomes in the surfactant era[J].Pediatrics,2007,120(6):1260-1269.
[2]陈超,袁琳.早产儿支气管肺发育不良的病因及危险因素[J].中国实用儿科杂志,2014,29(1):5-7.
[3]Jobe AH,Bancalari E.Bronchopulmonary dysplasia[J].Am J Respir Crit Care Med,2001,163(7):1723-1729.
[4]邵肖梅,叶鸿瑁,丘小汕,等.实用新生儿学[M].4版.北京:人民卫生出版社,2011.
[5]De Buyst J,Rakza T,Pennaforte T,et al.Hemodynamic effects of fluid restriction in preterm infants with significant patent ductus arteriosus[J].J Paediatr,2012,161(3):404-408.
[6]McEvoy CT,Aschner JL.The Natural history of bronchopulmonary dysplasia:the case for primary prevention[M].Clin Perinatol,2015,42(4):911-931.
[7]Northway WH Jr,Rosan RC,Porter DY.Pulmonary disease following respiratory therapy of hyalinemembrane disease Bronchopulmonary dysplasia[J].N Engl J Med,1967,276(7):357-368.
[8]McEvoy CT,Jain L,Schmidt B,et al.Bronchopulmonary dysplasia:NHLBI Workshop on the Primary Prevention of Chronic Lung Diseases[J].Ann Am Thorac Soc,2014,11(Suppl 3):S178.
[9]Barbara J,Stoll BJ,Hansen NI,et al.Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network[J].Pediatrics,2010,126(3):443-456.
[10]The Canadian Neonatal Network.Annual Report 2009[R/OL].http://www.canadianneonatalnetwork.org/Portal/LinkClick.aspx?fileticket=QleibWI8d10%3d&tabid=69[2018-03-21].2010.
[11]胡亚美,江载芳.诸福棠实用儿科学[M].7版.北京:人民卫生出版社,2012.
[12]Kallapur SG,Kramer BW,Nitsos I,et al.Pulmonary and systemic inflammatory responses to intra-amniotic IL-1alpha in fetal sheep[J].Am J Physiol Lung Cell Mol Physiol,2011,301(3):285-295.
[13]Abdel-Hady H,Nasef N,Shabaan AE,et al.Patent ductus arteriosus in preterm infants:do we have the right answers?[J].Biomed Res Int,2013,2013(4):676192.
[14]Evans N.Preterm patent ductus arteriosus:should we treat it?[J].J Paediatr Child Health,2012,48(9):753-758.
[15]Bhat R,Salas AA,Foster C,et al.Prospective analysis of pulmonary hypertension in extremely low birth weight infants[J].Pediatrics,2012,129(3):682-689.
[16]Slaughter JL,Pakrashi T,Jones DE,et al.Echocardiographic detection of pulmonary hypertension in extremely low birth weight infants with bronchopulmonary dysplasia requiring prolonged positive pressure ventilation[J].J Perinatol,2011,31(10):635-640.
[17]Mestan KK,Check J,Minturn L,et al.Placental pathologic changes of maternal vascular underperfusion in bronchopulmonary dysplasia and pulmonary hypertension[J].Placenta,2014,35(8):570-574.
[18]Slaughter JL,Pakrashi T,Jones DE.Echocardiographic detection of pulmonary hypertension in extremely low birth weight infants with bronchopulmonary dysplasia requiring prolonged positive pressure ventilation[J].Perinatol,2011,31(10):635.
[19]Khemani E,McElhinney DB,Rhein L,et al.Pulmonary artery hypertension in formerly premature infants with bronchopulmonary dysplasia:clinical features and outcomes in the surfactant era[J].Pediatrics,2007,120(6):1260-1269.