產(chǎn)重低于1500g的新生兒支氣管肺發(fā)育不良風(fēng)險預(yù)測模型的建立及效能分析
發(fā)布時間：2019-03-06 10:00
【摘要】：目的:建立早期預(yù)測產(chǎn)重低于1500g的新生兒發(fā)生支氣管肺發(fā)育不良(Bronchopulmonary dysplasia,BPD)的風(fēng)險預(yù)測模型,為預(yù)防BPD發(fā)生。及改善BPD預(yù)后提供有效指導(dǎo)。方法:對重慶醫(yī)科大學(xué)附屬兒童醫(yī)院新生兒科從2014年1月1日至2016年5月31日收治的產(chǎn)重低于1500g的311例新生兒進行回顧性分析。出生后28天仍需用氧者86例診斷為BPD組,生后28天時無需用氧者225例為非BPD組。對BPD組及對照組臨床特點進行分析比較。臨床特點包括以下方面:母親因素:母親年齡,子癇前期,妊娠糖尿病(Gestational diabetes mellitus,GDM),絨毛膜羊膜炎,胎膜早破(Premature rupture of membranes,PROM),羊水過少,雙胎或多胎妊娠,產(chǎn)前激素的使用,宮內(nèi)生長受限(Intrauterine growth restriction,IUGR),宮內(nèi)窘迫;新生兒相關(guān)因素:生產(chǎn)方式(剖宮產(chǎn)),新生兒窒息,產(chǎn)房復(fù)蘇,性別(男性),胎齡,產(chǎn)重,插管,新生兒呼吸窘迫綜合征(Neonatal respiratory distress syndrome,NRDS),動脈導(dǎo)管未閉(Patent ductus arteriosus,PDA),肺動脈高壓(Pulmonary hypertension,PH),顱內(nèi)出血(intraventricular hemorrhage,IVH),痰培養(yǎng)陽性,敗血癥,肺出血,生后3天內(nèi)液體總量均值、新生兒貧血、低鈣血癥、低血糖癥。對以上因素進行單因素分析。(3)對有統(tǒng)計學(xué)意義的臨床特點進行多因素logistic回歸,找出影響bpd發(fā)生的獨立危險因素,并建立風(fēng)險評估模型。運用roc曲線評估模型效能。(4)對2016年6月1日-2016年12月31日61例入住nicu患兒進行前瞻性評分。與生后28天情況比較,評估預(yù)測模型的效能。結(jié)果:產(chǎn)重1000g、1000g-1200g、1201g-1499g死亡率分別為17.4%,8.8%,4.8%。隨著體重的增加,新生兒死亡率明顯降低。單因素分析結(jié)果顯示:生產(chǎn)方式(剖宮產(chǎn)),新生兒窒息,產(chǎn)房復(fù)蘇,性別(男),胎齡,產(chǎn)重,nrds,pda,ph,ivh,痰培養(yǎng)陽性,敗血癥,肺出血,低鈣血癥這14個因素在兩組之間有顯著差異。而母親的年齡,子癇前期,gdm,絨毛羊膜炎,prom,雙胎或多胎妊娠,產(chǎn)前激素的使用,iugr,宮內(nèi)窘迫,生后3天內(nèi)液體總量均值,新生兒貧血,低血糖癥無統(tǒng)計學(xué)差異。進一步行多因素logistic回歸分析結(jié)果:新生兒窒息,性別(男性),痰培養(yǎng)陽性,敗血癥,肺動脈高壓為導(dǎo)致bpd發(fā)生的獨立危險因素。對2016年6月1日-2016年12月31日收入nicu患兒即檢驗組在生后7天內(nèi)進行評分。預(yù)測模型進行效能檢驗,預(yù)測的敏感度為91%,特異度為74%,陽性預(yù)測值為83%,陰性預(yù)測值為74%。說明該評分系統(tǒng)有較好的預(yù)測效能。結(jié)論:該風(fēng)險預(yù)測模型能夠較準確地篩查出極低出生體重兒中可能發(fā)生bpd的患兒,從而指導(dǎo)用藥,盡早采取干預(yù)bpd發(fā)生的措施。
[Abstract]:Aim: to establish an early predictive model for the risk of bronchopulmonary dysplasia (Bronchopulmonary dysplasia,BPD) in neonates with birth weight less than 1500g in order to prevent the occurrence of BPD. And improve the prognosis of BPD to provide effective guidance. Methods: 311 neonates whose birth weight was less than 1500g from January 1, 2014 to May 31, 2016 were analyzed retrospectively in the Department of Neonatal Pediatrics, affiliated Children's Hospital of Chongqing Medical University. 86 patients still needed oxygen at 28 days after birth were diagnosed as BPD group, while those who did not need oxygen at 28 days after birth were diagnosed as non-BPD group. The clinical characteristics of BPD group and control group were analyzed and compared. Clinical features include maternal factors: maternal age, preeclampsia, gestational diabetes mellitus (Gestational diabetes mellitus,GDM), chorioamnionitis, premature rupture of membranes (Premature rupture of membranes,PROM), oligohydramnios, twin or multiple pregnancies, Prenatal hormone use, intrauterine growth restriction (Intrauterine growth restriction,IUGR (IUGR), intrauterine distress; Neonatal related factors: mode of production (cesarean section), neonatal asphyxia, antepartum resuscitation, sex (male), gestational age, birth weight, intubation, neonatal respiratory distress syndrome (Neonatal respiratory distress syndrome,NRDS), patent ductus arteriosus (Patent ductus arteriosus, PDA), pulmonary hypertension (Pulmonary hypertension,PH), intracranial hemorrhage (intraventricular hemorrhage,IVH), sputum culture positive, septicemia, pulmonary hemorrhage, mean fluid volume within 3 days after birth, neonatal anemia, hypocalcemia, hypoglycemia. The above factors were analyzed by univariate analysis. (3) Multivariate logistic regression was performed to identify the independent risk factors affecting the occurrence of bpd, and a risk assessment model was established. The efficacy of the model was evaluated by roc curve. (4) 61 children admitted to nicu from June 1, 2016 to December 31, 2016 were evaluated prospectively. Compared with 28 days after birth, the effectiveness of the prediction model was evaluated. Results: the mortality rates were 17.4%, 8.8% and 4.8% respectively for 1 000 g, 1 000 g / kg, 1 201 g / kg and 1 201 g / kg, respectively. Neonatal mortality decreased significantly with weight gain. Univariate analysis showed that: mode of production (cesarean section), neonatal asphyxia, antepartum resuscitation, sex (male), gestational age, birth weight, positive nrds,pda,ph,ivh, sputum culture, septicemia, pulmonary hemorrhage, The 14 factors of hypocalcemia were significantly different between the two groups. However, there was no significant difference in maternal age, preeclampsia, gdm, chorioamnionitis, prom, twin or multiple pregnancy, prenatal hormone use, iugr, intrauterine distress, mean fluid volume within 3 days after birth, neonatal anemia and hypoglycemia. Further multivariate logistic regression analysis showed that neonatal asphyxia, sex (male), positive sputum culture, septicemia and pulmonary hypertension were independent risk factors for bpd. The children with nicu from June 1, 2016 to December 31, 2016 were evaluated within 7 days after birth. The sensitivity, specificity, positive predictive value and negative predictive value of the prediction model were 91%, 74%, 83% and 74%, respectively. This indicates that the scoring system has a good prediction efficiency. Conclusion: the risk prediction model can accurately screen children with bpd in very low birth weight infants, so as to guide the use of drugs and take measures to intervene the occurrence of bpd as soon as possible.
【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】：2017
【分類號】：R722.1
[Abstract]:Aim: to establish an early predictive model for the risk of bronchopulmonary dysplasia (Bronchopulmonary dysplasia,BPD) in neonates with birth weight less than 1500g in order to prevent the occurrence of BPD. And improve the prognosis of BPD to provide effective guidance. Methods: 311 neonates whose birth weight was less than 1500g from January 1, 2014 to May 31, 2016 were analyzed retrospectively in the Department of Neonatal Pediatrics, affiliated Children's Hospital of Chongqing Medical University. 86 patients still needed oxygen at 28 days after birth were diagnosed as BPD group, while those who did not need oxygen at 28 days after birth were diagnosed as non-BPD group. The clinical characteristics of BPD group and control group were analyzed and compared. Clinical features include maternal factors: maternal age, preeclampsia, gestational diabetes mellitus (Gestational diabetes mellitus,GDM), chorioamnionitis, premature rupture of membranes (Premature rupture of membranes,PROM), oligohydramnios, twin or multiple pregnancies, Prenatal hormone use, intrauterine growth restriction (Intrauterine growth restriction,IUGR (IUGR), intrauterine distress; Neonatal related factors: mode of production (cesarean section), neonatal asphyxia, antepartum resuscitation, sex (male), gestational age, birth weight, intubation, neonatal respiratory distress syndrome (Neonatal respiratory distress syndrome,NRDS), patent ductus arteriosus (Patent ductus arteriosus, PDA), pulmonary hypertension (Pulmonary hypertension,PH), intracranial hemorrhage (intraventricular hemorrhage,IVH), sputum culture positive, septicemia, pulmonary hemorrhage, mean fluid volume within 3 days after birth, neonatal anemia, hypocalcemia, hypoglycemia. The above factors were analyzed by univariate analysis. (3) Multivariate logistic regression was performed to identify the independent risk factors affecting the occurrence of bpd, and a risk assessment model was established. The efficacy of the model was evaluated by roc curve. (4) 61 children admitted to nicu from June 1, 2016 to December 31, 2016 were evaluated prospectively. Compared with 28 days after birth, the effectiveness of the prediction model was evaluated. Results: the mortality rates were 17.4%, 8.8% and 4.8% respectively for 1 000 g, 1 000 g / kg, 1 201 g / kg and 1 201 g / kg, respectively. Neonatal mortality decreased significantly with weight gain. Univariate analysis showed that: mode of production (cesarean section), neonatal asphyxia, antepartum resuscitation, sex (male), gestational age, birth weight, positive nrds,pda,ph,ivh, sputum culture, septicemia, pulmonary hemorrhage, The 14 factors of hypocalcemia were significantly different between the two groups. However, there was no significant difference in maternal age, preeclampsia, gdm, chorioamnionitis, prom, twin or multiple pregnancy, prenatal hormone use, iugr, intrauterine distress, mean fluid volume within 3 days after birth, neonatal anemia and hypoglycemia. Further multivariate logistic regression analysis showed that neonatal asphyxia, sex (male), positive sputum culture, septicemia and pulmonary hypertension were independent risk factors for bpd. The children with nicu from June 1, 2016 to December 31, 2016 were evaluated within 7 days after birth. The sensitivity, specificity, positive predictive value and negative predictive value of the prediction model were 91%, 74%, 83% and 74%, respectively. This indicates that the scoring system has a good prediction efficiency. Conclusion: the risk prediction model can accurately screen children with bpd in very low birth weight infants, so as to guide the use of drugs and take measures to intervene the occurrence of bpd as soon as possible.
【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】：2017
【分類號】：R722.1
【參考文獻】
相關(guān)期刊論文 前4條
1 陳洪;潘家華;;常頻機械通氣和鼻塞式持續(xù)氣道正壓通氣致早產(chǎn)兒支氣管肺發(fā)育不良的臨床比較[J];安徽醫(yī)藥;2014年12期
2 鄭國方;武榮;劉石;郝小清;;小胎齡早產(chǎn)兒支氣管肺發(fā)育不良發(fā)生率和危險因素分析[J];中國新生兒科雜志;2012年03期
3 早產(chǎn)兒支氣管肺發(fā)育不良調(diào)查協(xié)作組;容志惠;常立文;傅萬海;張U，
本文編號：2435427
本文鏈接：http://sikaile.net/yixuelunwen/eklw/2435427.html
最近更新
教材專著
