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目的 :探讨支气管肺发育不良(BPD)合并肺动脉高压(PH)的危险因素。方法 :收集2010年1月~2014年6月深圳市儿童医院新生儿重症监护病房收治的胎龄<32周的新生儿180例,依据BPD诊断标准,诊断为BPD 130例,8例先心病、13例持续肺动脉高压及9例先天性膈疝被剔出实验,余下100例分为轻度BPD 30例,中度BPD 44例,重度BPD 26例。在出生后2个月对纳入实验的100例BPD患儿行心脏超声检查,PH的诊断依据心脏超声诊断分为PH组或非PH组。对两组患儿的临床特征和结果进行回顾性分析。通过多因素Logistic回归分析BPD患儿并发PH的危险因素。结果:1轻度BPD合并PH比例低,中重度BPD合并PH比例较高,所有BPD患儿合并PH的比例为32.0%;2BPD患儿合并PH组及不合并PH组临床指标比较,5min Apagar评分≤6分、羊水过少、急性呼吸窘迫综合征、36周后仍需氧、绒毛膜羊膜炎两组间有统计学差异;3Logistic回归分析显示,5 min Apgar评分≤6分[RR=8.13,95%CI:2.48~26.62]、羊水过少[RR=16.69,95%CI:4.43~62.85]是PH的危险因素,提示低5 min Apgar评分≤6分、羊水过少为PH发生的独立危险因素。结论:5 min Apagar评分≤6分和羊水过少是BPD合并PH的危险因素。
Objective: To explore the risk factors of bronchopulmonary dysplasia (BPD) combined with pulmonary hypertension (PH). Methods: A total of 180 neonates with gestational age <32 weeks were enrolled in the Children’s Hospital of Shenzhen Children’s Hospital from January 2010 to June 2014. According to the BPD diagnostic criteria, 130 cases were diagnosed as BPD, 8 cases were diagnosed as CHD, 13 cases of persistent pulmonary hypertension and 9 cases of congenital diaphragmatic hernia were excluded from the experiment, the remaining 100 cases were divided into mild BPD in 30 cases, 44 cases of moderate BPD, 26 cases of severe BPD. Echocardiography was performed on 100 BPD-enrolled children 2 months after birth. The diagnosis of PH was divided into PH group and non-PH group based on the diagnosis of cardiac ultrasound. The clinical features and results of two groups of children were retrospectively analyzed. Multivariate logistic regression analysis was used to analyze the risk factors of PH in children with BPD. Results: 1 mild BPD with low PH ratio, moderate to severe BPD with a high proportion of PH, PHD in all children with PH was 32.0%; 2BPD children with PH group and non-PH group clinical indicators, 5min Apagar score ≤ 6 points, oligohydramnios, acute respiratory distress syndrome, still aerobic after 36 weeks, chorioamnionitis between the two groups were statistically significant; 3 Logistic regression analysis showed 5 min Apgar score ≤ 6 points [RR = 8.13, 95% CI: 2.48 ~ 26.62], oligohydramnios [RR = 16.69,95% CI: 4.43 ~ 62.85] were risk factors for PH, suggesting that the Apgar score was less than 6 points in 5 minutes and oligohydramnios were independent risk for PH factor. Conclusions: A 5 min Apagar score ≤ 6 and oligohydramnios are risk factors for BPD complicated with PH.