| 极早产儿出生后早期液体负荷与临床结局的关系 |
| 投稿时间：2024-12-12 修订日期：2025-01-05 点此下载全文 |
| 引用本文：范益丽,刘文强,徐艳,王军.极早产儿出生后早期液体负荷与临床结局的关系[J].医学研究杂志,2025,54(6):149-154 |
| DOI：
10.11969/j.issn.1673-548X.2025.06.027 |
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| 中文摘要:目的 分析极早产儿出生后早期液体负荷(fluid overload, FO)对有血流动力学意义的动脉导管未闭(hemodynamically significant patent ductus arteriosus, hsPDA)等临床结局的影响。方法 回顾性分析2021年11月～2024年7月徐州医科大学附属医院新生儿重症监护病房(neonatal intensive care unit, NICU)收治的胎龄(gestational age, GA)≤32周的极早产儿的临床资料。根据是否出现hsPDA分为hsPDA组和非hsPDA组,比较两组一般临床资料及出生后第1周每天的FO情况。采用多因素Logistic回归分析影响hsPDA的危险因素。以出生后第1天FO为检验变量,hsPDA为状态变量绘制受试者工作特征(receiver operator characteristic,ROC)曲线,计算FO截断值,并以该截断值为节点进行分组,分析极早产儿第1天FO与临床结局的关系。结果 共纳入153例GA≤32周的极早产儿,其中hsPDA组110例,非hsPDA组43例。单因素分析示两组极早产儿的出生体质量、1min Apgar评分、出生后使用抗生素时间、肠外营养时间、有创机械通气时间、无创机械通气时间、住院天数、第1天、第2天及第4天的FO比较,差异有统计学意义(P＜0.05)。多因素Logistic回归分析结果显示,有创机械通气时间、第1天FO是hsPDA的危险因素。以第1天FO为检验变量,hsPDA为状态变量绘制ROC曲线,曲线下面积(area under the curve,AUC)为0.903,敏感度和特异性分别为 79.1%和 89.1%,出生后第1天FO截断值为8.78%,以该截断值分组,分为FO≤8.78%组107例和FO＞8.78%组46例。单因素分析显示,FO＞8.78%组1min Apgar评分较低、有创机械通气时间较长、中重度支气管肺发育不良(bronchopulmonary dysplasia,BPD)、3～4级脑室内出血(intraventricular hemorrhage,IVH)的发生率高。多因素Logistic回归分析显示,出生后第1天FO＞8.78%是中重度BPD、3～4级IVH发生的危险因素。结论 极早产儿出生后第1天FO＞8.78%增加了hsPDA、中重度BPD、3～4级IVH的发生率。 |
| 中文关键词:极早产儿 液体负荷 有血流动力学的动脉导管未闭 并发症 |
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| Relationship between Early Fluid Overload in Very Preterm Infants and Clinical Outcomes. |
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| Abstract:Objective To analyze the effects of fluid overload (FO) on clinical outcomes of extremely preterm infants with hemodynamically significant patent ductus arteriosus (hsPDA). Methods This retrospective study analyzed data from neonates ≤32 weeks gestational age (GA) admitted to the Neonatal Intensive Care Unit (NICU) of the Affiliated Hospital of Xuzhou Medical University between November 2021 and July 2024. Infants were categorized into hsPDA and non-hsPDA groups based on the presence or absence of hsPDA. General clinical data and daily FO situation in the first week after birth of the two groups were compared, and the risk factors affecting hsPDA were obtained by Logistic regression analysis. Using the first day of postnatal FO as the test variable and hsPDA as the state variable, receiver operator characteristic (ROC) curve was drawn to calculate the cut-off value of FO, and the cut-off value was divided into groups to analyze the relationship between the first day FO and clinical outcome of very preterm infants. Results A total of 153 extremely preterm infants (GA≤32 weeks) were enrolled, including 110 in the hsPDA group and 43 in the non-HSPDA group. Univariate analysis showed that there were statistically significant differences in birth weight, 1-minute Apgar score, postnatal antibiotic use time, parenteral nutrition time, invasive mechanical ventilation time, non-invasive mechanical ventilation time, hospital days, day 1, day 2 and day 4 FO between the two groups (P<0.05). Multivariate Logistic regression analysis showed that invasive mechanical ventilation time and day 1 FO were risk factors of hsPDA. The ROC curve was drawn with the first day FO as the test variable and hsPDA as the state variable. The area under the curve was 0.903, the sensitivity and specificity were 79.1% and 89.1%, respectively, and the cut-off value of FO on the first day after birth was 8.78%. According to this cut-off value, 107 cases were divided into FO≤8.78% group and 46 cases were FO>8.78% group. Univariate analysis showed that FO>8.78% group had lower Apgar score at 1minute, longer invasive mechanical ventilation time, and higher incidence of moderate to severe bronchopulmonary dysplasia (BPD) and grade 3 to 4 intraventricular hemorrhage (IVH). Logistic regression analysis showed that FO>8.78% on the first day after birth was a risk factor for moderate to severe BPD and grade 3-4 IVH. Conclusion FO>8.78% on the first day after birth of very preterm infants increased the incidence of moderate to severe BPD and grade 3-4 IVH. |
| keywords:Extremely premature infants Fluid overload Hemodynamically significant patent ductus arteriosus Complication |
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