早产儿支气管肺发育不良伴肺动脉高压的临床特征及预后

Clinical features and prognosis of bronchopulmonary dysplasia complicated by pulmonary hypertension in preterm infants

摘要:

目的 调查早产儿支气管肺发育不良（BPD）并发肺动脉高压（PH）的临床特征及预后。方法 对191例BPD患儿的临床资料进行回顾性分析。结果 191例BPD患儿中，37例（19.4%）在纠正胎龄36周后并发PH，均发生于中度和重度BPD患儿，中度、重度BPD患儿的PH发生率分别为5.7%（5/87）和47.8%（32/67）。并发PH组患儿的出生胎龄、出生体重明显小于无PH组患儿（P < 0.01）；并发PH组患儿小于胎龄儿（SGA）比例、重度BPD比例、动脉导管未闭（PDA）手术率及新生儿呼吸窘迫综合征、有血流动力学意义的PDA、肺部感染的发生率明显高于无PH组（P < 0.01）；并发PH组患儿的吸氧、气管插管、正压通气时间均明显大于无PH组（P < 0.01）；并发PH组患儿的早产儿视网膜病、宫外生长发育迟缓发生率及病死率均明显高于无PH组，住院时间明显延长（P < 0.01）。37例PH患儿中（6例为轻度PH，14例中度，17例重度），轻、中度PH患儿均存活，重度PH患儿中15例（88%）死亡。结论 中重度BPD患儿的PH发生率较高，建议定期筛查BPD患儿的肺动脉压力。低出生胎龄和体重、SGA和重度BPD患儿更易并发PH。BPD并发PH患儿的并发症发生率和病死率较高，预后相对不良。

Abstract:

Objective To study the clinical features and prognosis of bronchopulmonary dysplasia (BPD) complicated by pulmonary hypertension (PH) in preterm infants. Methods A retrospective analysis was performed on the clinical data of 191 preterm infants with BPD. Results In the 191 preterm infants with BPD, 37 (19.4%), all with moderate or severe BPD, developed PH beyond 36 weeks' corrected age. The incidence rates of PH in infants with moderate and severe BPD were 5.7% (5/87) and 47.8% (32/67) respectively. Gestational age and birth weight were lower in infants with PH than in those without PH (P < 0.01). Infants with PH had higher incidence rates of small for gestational age (SGA), severe BPD, surgical ligation of patent ductus arteriosus (PDA), neonatal respiratory distress syndrome, hemodynamically significant PDA, and pneumonia than those without PH (P < 0.01). Durations of oxygen therapy, intubation, and positive pressure ventilation were longer in infants with PH than in those without PH (P < 0.01). Infants with PH had higher incidence rates of retinopathy of prematurity and extrauterine growth retardation, a higher mortality, and a longer length of hospital stay compared with those without PH (P < 0.01). In the 37 infants with PH (6 with mild PH, 14 with moderate PH, and 17 with severe PH), those with mild or moderate PH all survived; 15(88%) out of 17 infants with severe PH died. Conclusions The incidence of PH is high in preterm infants with moderate or severe BPD. Regular screening of pulmonary artery pressure is recommended for infants with BPD. Infants with low gestational age and birth weight, SGA, and severe BPD are more likely to develop PH. Infants with BPD complicated by PH have relatively high incidence rates of complications, high mortality, and poor prognosis.