本文關(guān)鍵詞： 支氣管肺發(fā)育不良 低出生體重兒 高危因素　出處：《重慶醫(yī)科大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討影響低出生體重兒（Lowbirthweightinfant,LBWI）支氣管肺發(fā)育不良發(fā)病及其嚴重程度的高危因素，為BPD的預(yù)防和治療提供意見。 方法：對重慶醫(yī)科大學(xué)附屬兒童醫(yī)院新生兒重癥監(jiān)護室（Neonatalintensivecareunit,NICU）自2010年1月1日至2011年12月31日收治的體重＜2500g的1932例新生兒進行回顧性分析，其中生后持續(xù)用氧≥28d者50例，即支氣管肺發(fā)育不良（Bronchopulmonarydysplasia,BPD）組；生后28d未用氧者1882例，即非BPD組。（1）將低出生體重兒按產(chǎn)重＜1000g，1000-1249g，1250-1499g，，1500-1749g，1750-1999g，2000-2249g，2250-2499g進行分組，計算各不同產(chǎn)重組BPD的患病率；（2）BPD組有9例因入院日齡過大、資料不全剔除，從非BPD組按產(chǎn)重隨機選取41例，作為對照組，對兩組患兒的臨床資料進行對比分析；并對兩組患兒生后3天內(nèi)、7天內(nèi)、10天內(nèi)的總液體量、熱卡攝入以及體重增長的速度進行對比研究。（3）根據(jù)患兒胎齡及不同胎齡生后持續(xù)用氧情況將BPD組分為輕度和中重度，比較兩組臨床資料。臨床資料結(jié)果均采用計量或計數(shù)資料表示，計量資料首先檢查正態(tài)性，若滿足正態(tài)分布采取T檢驗，若不滿足正態(tài)分布則采取非參數(shù)檢驗法；計數(shù)資料采用卡方檢驗（若出現(xiàn)理論頻數(shù)＜1，則采用fisher精確概率法）比較兩組資料之間的差異；Logistic回歸分析找出BPD發(fā)病及病情分級程度的主要影響因素。 結(jié)果：本院產(chǎn)重＜1000g，1000-1249g，1250-1499g，1500-1749g，1750-1999g，2000-2249g，2250-2499g的早產(chǎn)兒支氣管肺發(fā)育不良的患病率分別為：10.34%、16.28%、4.97%、2.77%、1.52%、1.20%、0.72%，BPD的患病率總體隨著產(chǎn)重的增加明顯降低，單因素卡方檢驗分析結(jié)果顯示:新生兒呼吸窘迫綜合征（Respiratorydistresssyndrome,RDS）、呼吸衰竭、呼吸暫停、肺出血、危重病例等級、早產(chǎn)兒HB＜128.5g/L、機械通氣、呼吸機持續(xù)時間＞7天、PaO2/FiO2＜300以及動脈導(dǎo)管未閉使用這10個因素在BPD組和非BPD組有顯著差異。多因素Logistic回歸向后步近法分析結(jié)果顯示，血紅蛋白（Hemoglobin,HB）＜128.5g/L、呼吸衰竭、呼吸暫停、動脈導(dǎo)管未閉(Patentductusarteriosus,PDA)為BPD發(fā)生的獨立高危因素。BPD組與非BPD組患兒生后3天、7天、10天總液體量攝入、7-10日齡至出院前體重增長速度以及維生素A攝入量組間比較無顯著的差異，而BPD組患兒生后3天、7天、10天總熱卡攝入及住院期間平均HB較對照組明顯降低。41例病例中輕度支氣管肺發(fā)育不良17例，中重度24例。孕周＜32周是唯一對BPD病情嚴重程度有統(tǒng)計學(xué)差異的指標（P=0.024）。 結(jié)論：我院低出生體重兒支氣管肺發(fā)育不良的患病率為2.59%，患病率和體重呈負相關(guān)，呼吸衰竭、呼吸暫停、HB＜128.5g/L、PDA是BPD發(fā)生的獨立高危因素，BPD組總能量攝入明顯低于非BPD組。孕周＜32周是制約BPD發(fā)病嚴重程度的高危因素。
[Abstract]:Objective: to investigate the risk factors affecting the incidence and severity of bronchopulmonary dysplasia in low birthweight infants (LBWI). Provide advice on prevention and treatment of BPD. Methods: Neonatrical intensive care unit (NICU) of the Children's Hospital affiliated to Chongqing Medical University was used. From January 1st 2010 to December 31st 2011, 1 932 newborns weighing less than 2500g were analyzed retrospectively. Among them, 50 cases were treated with oxygen for more than 28 days after birth, that is, bronchopulmonary dysplasia (BPD) group. After 28 days of birth, 1 882 cases (non-#en0# group) were treated with low birth weight infants according to birth weight < 1000g / 1000-1249g / 1250-1499g. 1500-1749g / L 1750-1999g / 2000 2249g / 2250-2499g were grouped to calculate the prevalence rate of recombinant BPD in different production. Nine cases of bpd were selected randomly from non-#en0# group according to birth weight because of excessive age of admission and incomplete removal of data. The clinical data of the two groups were compared and analyzed. The total liquid volume within 7 days and 10 days after birth was measured in both groups. A comparative study of hot calorie intake and the rate of weight gain. 3) the BPD components were divided into mild and moderate severe groups according to their gestational age and continuous oxygen use after birth at different gestational ages. Two groups of clinical data were compared. The results of clinical data were expressed by metrological or counting data. The measured data were first examined for normality, and T test was adopted if normal distribution was satisfied. If the normal distribution is not satisfied, the nonparametric test method is adopted. The difference between the two groups of data was compared by chi-square test (if theoretical frequency < 1, fisher accurate probability method). Logistic regression analysis found out the main factors influencing the incidence and severity of BPD. Results: the weight of production in our hospital was less than 1000g / 1000-1249g / 1250-1499g / 1500-1749g / 1750-1999g / 2000-2249g. The prevalence of bronchopulmonary dysplasia in preterm infants of 2250-2499g was 10. 34% and 16. 28%, respectively. The prevalence of bpd decreased with the increase of birth weight. The results of univariate chi-square test showed that neonatal respiratory distress syndrome (RDS), respiratory failure and apnea. Pulmonary hemorrhage, critical case grade, HB < 128.5 g / L, mechanical ventilation, ventilator duration > 7 days. PaO2/FiO2 < 300 and the use of patent ductus arteriosus were significantly different between BPD group and non-#en2# group. Multivariate Logistic regression analysis showed that. . Hemoglobin B < 128.5 g / L, respiratory failure, apnea, patent ductus arteriosus. PDAA was an independent risk factor for the occurrence of BPD. The total liquid intake of bpd group and non BPD group was 7 days and 10 days after birth. There was no significant difference in body weight growth rate and vitamin A intake between 7-10 days old and pre-discharge group, while in BPD group there was no significant difference between 3 days and 7 days after birth. Total calorie intake and average HB during hospitalization were significantly lower in 10 days than in the control group. 17 cases were mild bronchopulmonary dysplasia. There were 24 moderate and severe cases. Gestational age less than 32 weeks was the only index with significant difference in severity of BPD. Conclusion: the prevalence of bronchopulmonary dysplasia in low birth weight infants was 2.59. The prevalence rate was negatively correlated with body weight, respiratory failure, apnea HB < 128.5 g / L. PDA was an independent risk factor for the occurrence of BPD. The total energy intake of bpd group was significantly lower than that of non-#en2# group, and the gestational age less than 32 weeks was the high risk factor to restrict the severity of BPD.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R722

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