[极早早产儿出生后72小时内低血压的危险因素及预后]
[Risk factors and prognosis of hypotension within 72 hours after birth in extremely preterm infants].
作者信息
Liu Tai-Xiang, Shi Li-Ping
机构信息
Department of Neonatal Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine/National Clinical Research Center for Child Health, Hangzhou 310052, China.
出版信息
Zhongguo Dang Dai Er Ke Za Zhi. 2023 Oct 15;25(10):1001-1007. doi: 10.7499/j.issn.1008-8830.2304027.
OBJECTIVES
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 (<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 (<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%: 0.802-0.944, <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.
目的
探讨极早早产儿出生后72小时内发生低血压的危险因素及预后情况。
方法
对2019年1月至2022年4月浙江大学医学院附属儿童医院收治的极早早产儿临床资料进行回顾性分析。根据出生后72小时内是否发生低血压，将符合条件的婴儿分为低血压组（41例）和正常血压组（82例）。比较两组的临床特征、出生后72小时内的超声心动图参数及早期并发症。采用多因素logistic回归分析探讨出生后72小时内低血压的危险因素，并进行受试者工作特征曲线分析，以评估相关指标对极早早产儿出生后72小时内发生低血压的预测价值。
结果
低血压组中需要药物治疗或手术关闭动脉导管未闭（PDA）的婴儿比例、脑室内出血≥Ⅲ级和严重肺出血的婴儿比例以及7天内的死亡率均显著高于正常血压组（<0.05）。多因素logistic回归分析显示，出生体重较低、PDA直径较大及血流动力学显著的PDA是极早早产儿出生后72小时内发生低血压的危险因素（<0.05）。受试者工作特征曲线分析显示，出生体重、PDA直径及血流动力学显著的PDA联合预测出生后72小时内低血压的曲线下面积为0.873（95%：0.802 - 0.944，<0.05），灵敏度为73.2%，特异度为91.5%。
结论
出生后72小时内的低血压与出生体重和PDA密切相关，增加了极早早产儿早期严重并发症及死亡的风险。
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