2007~2016年10年间早产儿肺出血的治疗与预后分析

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

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.