2007~2016年10年间早产儿肺出血的治疗与预后分析

潘维伟, 童笑梅

中国当代儿科杂志 ›› 2018, Vol. 20 ›› Issue (4) : 255-260.

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中国当代儿科杂志 ›› 2018, Vol. 20 ›› Issue (4) : 255-260. DOI: 10.7499/j.issn.1008-8830.2018.04.001
论著·临床研究

2007~2016年10年间早产儿肺出血的治疗与预后分析

  • 潘维伟, 童笑梅
作者信息 +

Treatment and prognosis of pulmonary hemorrhage in preterm infants during 2007-2016

  • PAN Wei-Wei, TONG Xiao-Mei
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摘要

目的 探讨早产儿肺出血的治疗与预后。方法 选择北京大学第三医院2007~2016年在新生儿病房住院并诊断为肺出血的早产儿106例为研究对象。根据住院时间分为2007~2011年组(34例)和2012~2016年组(72例);根据肺出血发生后使用的不同呼吸支持方法分为常频通气组(43例)和高频振荡通气组(HFOV组,63例);根据在肺出血之前未关闭PDA是否给予PDA结扎术分为未手术组(34例)和手术组(14例)。按照3种不同分组方法对患儿的基本情况、治疗方法及预后进行比较分析。结果 2012~2016年组使用HFOV和PDA结扎术的比例高于2007~2011年组(P < 0.05);2012~2016年组住院期间病死率低于2007~2011年组,住院时间长于2007~2011年组(P < 0.05);2012~2016年组颅内出血、支气管肺发育不良(BPD)的发生率高于2007~2011年组(P < 0.05)。HFOV组住院期间病死率低于常频通气组,住院时间长于常频通气组(P < 0.05);HFOV组颅内出血、BPD的发生率高于常频通气组(P < 0.05)。PDA手术组住院期间病死率低于未手术组,住院时间长于未手术组(P < 0.05);PDA手术组颅内出血、BPD的发生率高于未手术组(P < 0.05)。结论 HFOV和PDA结扎术的应用可使早产儿肺出血的生存率得到改善,但颅内出血、BPD的发生率也相应升高。

Abstract

Objective To study the treatment and prognosis of pulmonary hemorrhage in preterm infants. Methods A total of 106 preterm infants diagnosed with pulmonary hemorrhage, who were hospitalized in the neonatal ward of Peking University Third Hospital between 2007 and 2016, were enrolled. These patients were divided into 2007-2011 group (34 cases) and 2012-2016 group (72 cases) according to the time of hospitalization, divided into conventional-frequency ventilation group (43 cases) and high-frequency oscillatory ventilation (HFOV) group (63 cases) according to the respiratory support method used after the development of pulmonary hemorrhage, and divided into non-operation group (34 cases) and operation group (14 cases) according to whether PDA ligation was performed for the unclosed PDA before pulmonary hemorrhage. The general data, treatment, and prognosis were compared between different groups. Results Compared with the 2007-2011 group, the 2012-2016 group had higher rates of HFOV and PDA ligation (P < 0.05), a lower mortality rate during hospitalization (P < 0.05), a longer length of hospital stay (P < 0.05), and higher incidence rates of intracranial hemorrhage and bronchopulmonary dysplasia (P < 0.05). Compared with the conventional-frequency ventilation group, the HFOV group had a lower mortality rate during hospitalization (P < 0.05), a longer length of hospital stay (P < 0.05), and higher incidence rates of intracranial hemorrhage and bronchopulmonary dysplasia (P < 0.05). Compared with the non-operation group, the operation group had a lower mortality rate during hospitalization (P < 0.05), a longer length of hospital stay (P < 0.05), and higher incidence rates of intracranial hemorrhage and bronchopulmonary dysplasia (P < 0.05). Conclusions The application of HFOV and PDA ligation can improve the survival rate of preterm infants with pulmonary hemorrhage, but the incidence of intracranial hemorrhage and bronchopulmonary dysplasia is also increased.

关键词

肺出血 / 治疗 / 预后 / 早产儿

Key words

Pulmonary hemorrhage / Treatment / Prognosis / Preterm infant

引用本文

导出引用
潘维伟, 童笑梅. 2007~2016年10年间早产儿肺出血的治疗与预后分析[J]. 中国当代儿科杂志. 2018, 20(4): 255-260 https://doi.org/10.7499/j.issn.1008-8830.2018.04.001
PAN Wei-Wei, TONG Xiao-Mei. Treatment and prognosis of pulmonary hemorrhage in preterm infants during 2007-2016[J]. Chinese Journal of Contemporary Pediatrics. 2018, 20(4): 255-260 https://doi.org/10.7499/j.issn.1008-8830.2018.04.001

参考文献

[1] 陈超. 肺出血[M]//邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学. 第4版. 北京:人民卫生出版社, 2011:408-410.
[2] Lodha A, Kamaluddeen M, Akierman A, et al. Role of hemocoagulase in pulmonary hemorrhage in preterm infants:a systematic review[J]. Indian J Pediatr, 2011, 78(7):838-844.
[3] Berger TM, Allred EN, Van Marter LJ. Antecedents of clinically significant pulmonary hemorrhage among newborn infants[J]. J Perinatol, 2000, 20(5):295-300.
[4] 邵肖梅, 叶鸿瑁, 丘小汕.实用新生儿学[M].第4版. 北京:人民卫生出版社, 2011:222-225, 340-347, 395-398, 416-423, 534-540, 634-639, 706-715, 755-763, 887-892.
[5] 范洁, 黑明燕, 黄西林, 等.一所地市级医院NICU中新生儿肺出血的高危因素分析[J]. 中国当代儿科杂志, 2017, 19(3):346-349.
[6] Battin MR, Knight DB, Kuschel CA, et al. Improvement in mortality of very low birthweight infants and the changing pattern of neonatal mortality:the 50-year experience of one perinatal centre[J]. J Paediatr Child Health, 2012, 48(7):596-599.
[7] 王恋, 李娟, 毛健, 等. 极低及超低出生体重儿的预后因素分析[J]. 中国当代儿科杂志, 2014, 16(6):601-605.
[8] 蔡蜊璇, 展爱红, 赵奕怀, 等. 新生儿肺出血高危因素及早期诊断的临床分析[J]. 中国妇幼保健, 2007, 16(23):2211-2214.
[9] Raju TNK. Neonatal pulmonary hemorrhage[M]//Manual of Neonatal Respiratory Care. Bethesda:Springer US, 2012:665-674.
[10] Terragni PP, Rosboch G, Tealdi A, et al. Tidal hyperinflation during low tidal volume ventilation in acute respiratory distress syndrome[J]. Am J Respir Crit Care Med, 2007, 175(2):160-166.
[11] 陈丹, 黄西林, 李小萍, 等. 高频振荡通气治疗新生儿肺出血的临床研究[J]. 临床儿科杂志, 2011, 29(3):212-215.
[12] 王华, 杜立中, 唐军, 等. 首选使用高频振荡通气治疗新生儿肺出血的临床效果分析[J]. 中国当代儿科杂志, 2015, 17(3):213-216.
[13] 林新祝, 赖基栋, 吕梅, 等. 高频振荡通气联合肺表面活性物质治疗新生儿肺出血的疗效观察[J]. 中国当代儿科杂志, 2015, 17(4):345-349.
[14] 杨江帆, 李炜, 杨戎威, 等. 新生儿动脉导管未闭并发心力衰竭急性肺水肿(附14例报告)[J]. 小儿急救医学, 2002, 9(2):211-213.
[15] Kluckow M, Evans N. Ductal shunting, high pulmonary blood flow, and pulmonary hemorrhage[J]. J Pediatr, 2000, 137(1):68-72.
[16] Lee J, Rajadurai VS, Tan KW, et al. Randomized trial of prolonged low-dose versus conventional-dose indomethacin for treating patent ductus arteriosus in very low birth weight infants[J]. Pediatrics, 2003, 112(2):345-350.
[17] Fischer HS, Bührer C. Avoiding endotracheal ventilation to prevent bronchopulmonary dysplasia:a meta-analysis[J]. Pediatrics, 2013, 132(5):e1351-e1360.
[18] Wadhawan R, Oh W, Perritt R, et al. Association between early postnatal weight loss and death or BPD in small and appropriate for gestational age extremely low-birth-weight infants[J]. J Perinatol, 2007, 27(6):359-364.


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