Chen Dan, Wang Meng, Wang Xin, Ding Xue-Wei, Ba Rui-Hua, Mao Jian
Department of Neonatology, Shengjing Hospital, China Medical University, Shenyang 110004, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2017 Jan;19(1):54-58. doi: 10.7499/j.issn.1008-8830.2017.01.008.
To explore the high-risk factors and analyze the clinical characteristics of massive pulmonary hemorrhage (MPH) in infants with extremely low birth weight (ELBW).
Two hundred and eleven ELBW infants were included in this study. Thirty-five ELBW infants who were diagnosed with MPH were labelled as the MPH group, and 176 ELBW infants without pulmonary hemorrhage were labelled as the control group. The differences in clinical characteristics, mortality rate, and incidence of complications between the two groups were analysed. The high-risk factors for MPH were identified by multiple logistic regression analysis.
The MPH group had significantly lower gestational age, birth weight, and 5-minute Apgar score than the control group (P<0.05). The MPH group had significantly higher rates of neonatal respiratory distress syndrome, patent ductus arteriosus (PDA), early-onset sepsis (EOS), intracranial hemorrhage, pulmonary surfactant utilization, and death compared with the control group (P<0.01). The multiple logistic regression analysis showed that 5-minute Apgar score was a protective factor for MPH (OR=0.666, P<0.05), and that PDA and EOS were risk factors for MPH (OR=3.717, 3.276 respectively; P<0.01). In the infants who were discharged normally, the MPH group had a longer duration of auxiliary ventilation and a higher incidence rate of ventilator-associated pneumonia (VAP) compared with the control group (P<0.05).
A higher 5-minute Apgar score is associated a decreased risk for MPH, and the prensence of PDA or EOS is associated an increased risk for MPH in ELBW infants. ELBW infants with MPH have a prolonged mechanical ventilation, a higher mortality, and higher incidence rates of VAP and intracranial hemorrhage compared with those without pulmonary hemorrhage.
探讨极低出生体重（ELBW）儿大量肺出血（MPH）的高危因素并分析其临床特征。
本研究纳入211例ELBW儿。35例诊断为MPH的ELBW儿被标记为MPH组，176例无肺出血的ELBW儿被标记为对照组。分析两组临床特征、死亡率及并发症发生率的差异。通过多因素logistic回归分析确定MPH的高危因素。
MPH组的胎龄、出生体重及5分钟阿氏评分显著低于对照组（P<0.05）。与对照组相比，MPH组新生儿呼吸窘迫综合征、动脉导管未闭（PDA）、早发型败血症（EOS）、颅内出血、肺表面活性物质使用率及死亡率显著更高（P<0.01）。多因素logistic回归分析显示，5分钟阿氏评分是MPH的保护因素（OR=0.666，P<0.05），PDA和EOS是MPH的危险因素（OR分别为3.717、3.276；P<0.01）。在正常出院的婴儿中，MPH组辅助通气时间更长，呼吸机相关性肺炎（VAP）发生率更高，与对照组相比差异有统计学意义（P<0.05）。
较高的5分钟阿氏评分与ELBW儿MPH风险降低相关，PDA或EOS的存在与ELBW儿MPH风险增加相关。与无肺出血的ELBW儿相比，发生MPH的ELBW儿机械通气时间延长、死亡率更高，VAP和颅内出血发生率更高。
