摘要
目的了解新生儿重症监护室内新生儿用氧情况及长期需氧疗发生率及临床特点。方法回顾性分析2009年10月至2011年5月我院新生儿重症监护室收治的12155例新生儿用氧情况及相关临床资料，并与国内19所医院调查结果进行比较。结果在纳入的12155例新生儿中，足月儿4951例，早产儿7204例，共有102例用氧超过28d，发生率为0．84％（102／12155）。102例患儿中，早产儿88例，足月儿14例；出生胎龄（31．16±3．70）周；出生体重（1．60±0．68）kg；用氧时间（40．62±12．25）d；治愈或好转98例，死亡4例。7204例早产儿按持续吸氧超过生后28d的标准，支气管肺发育不良（bronchopulmonarydysplasia，BPD）发生率为1．22％（88／7204）。出生胎龄32周以下的早产儿，如以需氧疗时问超过生后28d为标准，BPD发生率为4．92％（68／1381），如以需氧疗时间超过矫正胎龄36周为标准，BPD发生率仅为2．10％（29／1381），两者BPD发生率比较差异有统计学意义（X2=16．251，P〈0．001）。整体比较5499例不同出生胎龄患儿的用氧比例（X2=119．99）、吸氧持续时间（F=109．27），差异均有统计学意义（P〈0．001），但不同胎龄长期氧依赖患儿的平均用氧和机械通气时间差异无统计学意义（P〉0．05）。不同胎龄的长期氧依赖患儿在肺表面活性物质应用、心力衰竭、早产儿视网膜病变、先天性心脏病及其他先天畸形发生率和预后方面差异有统计学意义（X2=8．789，13．538，23．176，7．778，8．842，8．246，P〈0．05）。我院与国内19所医院调查数据比较，患儿校正超长期用氧率分别为0．99％（71／7204）和1．54％（190／12351），差异有统计学意义（x2=10．558，P〈0．001）。结论我院住院早产儿BPD发生率较低。胎龄小、肺发育不成熟及继发的肺损伤可能是需超长期用氧的主要原因。较大胎龄新生儿长期氧依赖应注意除外先天性心脏病、先天畸形等因素。胎龄32周以下早产儿BPD诊断标准仍有待商榷。
Objective To investigate the situation of oxygen supplement and the incidence and clinical characteristics of long-term oxygen inhalation newborns in neonatal intensive care unit（NICU）. Methods The records of oxygen supplement and the related clinical data of 12 155 neonates admitted in our NICU from Oct 2009 to May 2011 were collected and retrospectively analyzed. The results were compared with the data from a survey on 19 hospitals in China which reported by other authors. Results In 12 155 newborns, 4 951 were full term,7 204 were preterm. One hundred and two patients（0. 84% ,102/12 155） accepted oxygen for more than 28 days. Among them, 88 were preterm, 14 were full term, with the average gestational age （31.16 ±3.70） weeks,the average birth weight （ 1.60 ±0. 68） kg and the mean oxygen supplement period （ 40. 60 ± 12. 25 ） d. Finally ,98 were cured or improved ,4 died. The incidence of bronchopulmonary dysplasia （BPD） in 7 204 preterm infants was 1.22% （88/7 204）according to the standard of continuous oxygen supply more than 28 days after birth. The incidence of BPD in preterm infants less than 32 weeks was 4. 92% （68/1 381 ） according to the standard of continuous oxygen supply more than 28 days after birth, while the rate was only 2. 10% （29/1 381 ） according to the standard of continuous oxygen supply more than 36 weeks postmenstrual age. The rates of BPD according to the two different standards were significantly different （ X2 = 16. 251 ,P 〈0. 001 ）. There were significant differences in the rate of supply oxygen（ X2 = 119.99） and supply oxygen time（F= 109.27 ）among different gestational age groups in overall the 5 499 neonates （P 〈 0. 001 ） ,but no significant differences in the average time of oxygen supply and mechanical ventilation among different gestational age groups in infants with long-term oxygen dependence （ P 〉 0.05 ）. There were significant differences in rates of pulmonary surfactant therapy, heart failure, retinopathy of prematurity, congenital heart disease, other congenital malformation and mortality among different gestational age groups in long-term oxygen dependence infants （X2 = 8. 789,13. 538,23. 176,7.778,8. 842,8. 246, P 〈 0. 05 ）. As compared with the data from 19 hospitals, the corrected rate of long-term oxygen supplement in preterm infants in our hospital was obviously lower[0. 99% （71/7 204） vs 1.54% （ 190/12 351 ） ,P 〈 0. 001 ]. Conclusion The incidence of BPD in our NICU is low. Lower gestational age, immature lung and secondary lung injury may be the mainly cause of neonatal long-term oxygen dependence, but some factors such as congenital heart disease, congenital malformations should be considered in more mature infants. The most appropriate standard for BPD still remains to be discussed.
出处
《中国小儿急救医学》
CAS
2012年第2期139-143,共5页
Chinese Pediatric Emergency Medicine
基金
国家自然科学基金面上项目（81170602,30973210）
国家自然科学基金青年项目（81000265）
关键词
氧疗
支气管肺发育不良
婴儿
新生
Oxygen therapy
Bronchopulmonary dysplasia
Infant, newborn
