超早产儿生后72 h内低血压发生的危险因素及预后分析

Risk factors and prognosis of hypotension within 72 hours after birth in extremely preterm infants

摘要:

目的 探讨超早产儿生后72 h内低血压的危险因素和预后。方法 回顾性分析2019年1月—2022年4月于浙江大学医学院附属儿童医院收治的超早产儿住院期间的临床资料。根据生后72 h内是否存在低血压，将入选患儿分为低血压组（41例）和正常血压组（82例），比较2组的临床特征、出生后72 h内的超声心动图参数和早期并发症，并采用多因素logistic回归分析探讨生后72 h内低血压的危险因素。采用受试者操作特征曲线分析评估相关指标预测超早产儿生后72 h内发生低血压的价值。结果 低血压组7 d内药物或手术关闭动脉导管未闭（patent ductus arteriosus, PDA）、≥Ⅲ度脑室内出血和严重肺出血的患儿比例及7 d内病死率显著高于正常血压组（P<0.05）。多因素logistic回归分析显示，出生体重较低、PDA直径较大及有血流动力学意义的PDA是超早产儿生后72 h内发生低血压的危险因素（P<0.05）。受试者操作特征曲线分析显示，出生体重、PDA直径、有血流动力学意义的PDA 3个指标联合预测超早产儿生后72 h内发生低血压的曲线下面积为0.873（95%CI：0.802~0.944，P<0.05），灵敏度和特异度分别为73.2%和91.5%。结论 超早产儿生后72 h内低血压的发生与出生体重和PDA密切相关，并增加早期严重并发症和死亡的发生风险。

Abstract:

Objective To investigate the risk factors and prognosis of hypotension within 72 hours after birth in extremely preterm infants.Methods A retrospective analysis was conducted on clinical data of extremely preterm infants admitted to the Children's Hospital of Zhejiang University School of Medicine from January 2019 to April 2022. Based on the presence of hypotension within 72 hours after birth, the eligible infants were divided into a hypotension group (41 cases) and a normotension group (82 cases). The clinical characteristics, echocardiographic parameters within 72 hours after birth, and early complications were compared between the two groups. Multivariate logistic regression analysis was used to explore the risk factors for hypotension within 72 hours after birth, and receiver operating characteristic curve analysis was performed to evaluate the predictive value of relevant indicators for the occurrence of hypotension within 72 hours after birth in the preterm infants.Results The proportion of infants who required medication or surgical closure of patent ductus arteriosus (PDA), the proportions of infants with intraventricular hemorrhage ≥ grade III and severe pulmonary hemorrhage, and the mortality rate within 7 days in the hypotension group were significantly higher than those in the normotension group (P<0.05). Multivariate logistic regression analysis showed that lower birth weight, larger PDA diameter, and hemodynamically significant PDA were risk factors for the occurrence of hypotension within 72 hours after birth in extremely preterm infants (P<0.05). The receiver operating characteristic curve analysis showed that the combination of birth weight, PDA diameter, and hemodynamically significant PDA had an area under the curve of 0.873 (95%CI: 0.802-0.944, P<0.05) for predicting hypotension within 72 hours after birth, with a sensitivity of 73.2% and specificity of 91.5%.Conclusions Hypotension within 72 hours after birth is closely related to birth weight and PDA, and increases the risk of early severe complications and mortality in extremely preterm infants.