早产儿动脉导管未闭的危险因素及相关并发症分析

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摘要目的探讨1 044例早产儿动脉导管未闭(PDA)的发生率、危险因素及相关并发症的发生情况。方法选择2016年5月-2019年4月华中科技大学同济医学院附属同济医院新生儿科收治的早产儿(胎龄<34周)作为研究对象,根据生后一周内超声心动图结果分为PDA组(249例)和对照组(795例),收集两组早产儿的临床资料进行病例对照研究,对PDA发生的相关因素进行单因素分析,并建立二元Logistic回归模型,分析PDA的危险因素及相关并发症的发生情况。结果胎龄小于34周早产儿PDA发生率为23.9%。且胎龄和出生体重越小,PDA发生率越高。单因素分析结果显示,胎龄、出生体重、窒息、妊娠高血压、产前糖皮质激素使用、胎膜早破与PDA的发生有关(P<0.05)。多因素二元Logistic回归分析显示,胎龄小(OR=1.40,95% CI:1.24～1.59)、窒息(OR=1.82,95% CI:1.21～2.75)是PDA发生的独立危险因素;胎膜早破(OR=0.63,95% CI:0.45～0.88)、产前糖皮质激素使用(OR=0.52,95% CI:0.36～0.76)是PDA的独立保护因素。PDA组患儿有创及无创呼吸机应用、肺炎、早产儿支气管肺发育不良(BPD)、喂养不耐受、Bell分期II期以上坏死性小肠结肠炎(NEC)、颅内出血(IVH)、早产儿视网膜病变(ROP)及肾损伤的发生率高于对照组,差异有统计学意义,两组患儿在脑室周围白质软化(PVL)的发生率之间的差异无统计学意义。结论早产儿胎龄和出生体重越小,PDA发生率越高;胎龄小和窒息是早产儿PDA的高危因素之一,而产前激素使用和胎膜早破是其保护因素。早产儿PDA可引起呼吸机应用时间延长,增加肺炎、BPD、喂养不耐受、NEC、IVH、ROP及肾损伤的发生率。

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关键词 ：动脉导管未闭, 危险因素, 并发症, 早产儿

收稿日期: 2020-08-13

基金资助:湖北省卫生计生科研项目(WJ2019M125)

通讯作者: 陈玲(chenling@tjh.tjmu.edu.cn)

引用本文:

孙玄, 陈玲, 周建华, 高金枝, 胡晓琳. 早产儿动脉导管未闭的危险因素及相关并发症分析[J]. 中国生育健康杂志, 2021, 32(2): 153-156.

链接本文:

http://cjrh.bjmu.edu.cn/CN/ 或 http://cjrh.bjmu.edu.cn/CN/Y2021/V32/I2/153

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