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南京医科大学学报(自然科学版) 第42卷第10期
·1440 · Journal of Nanjing Medical University(Natural Sciences) 2022年10月
·临床研究·
极早和超早产儿支气管肺发育不良的回顾性研究
沈 仙 ,陈 许 ,卢刻羽 ,朱 雯 ,陆亚东 ,程 锐 ,莫绪明 2*
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南京医科大学附属儿童医院新生儿医疗中心,心胸外科,江苏 南京 210008
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[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(1 132.18±251.25)g,<1 000 g的超低出生体重儿占28.6%,而非BPD组出生体重(1 384.47±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。
[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
[中图分类号] R722.1 [文献标志码] A [文章编号] 1007⁃4368(2022)10⁃1440⁃06
doi:10.7655/NYDXBNS20221014
Retrospective study of bronchopulmonary dysplasia in very preterm infants and extremely
preterm infants
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SHEN Xian ,CHEN Xu ,LU Keyu ,ZHU Wen ,LU Yadong ,CHENG Rui ,MO Xuming 2*
1 Department of Neonatology,Depa6rtment of Cardiothoracic Surgery Children’s Hospital of Nanjing Medical
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University,Nanjing 210008,China
[Abstract] 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 < 1 000 g accounted for 28.6% ,while that of non ⁃ BPD group was
1384.47±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
[基金项目] 南京市医学科技发展项目(YKK17157)
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通信作者(Corresponding author),E⁃mail:mohsuming15@njmu.edu.cn