实用医学杂志2025，Vol.41Issue(10)：1575-1583,9.DOI:10.3969/j.issn.1006-5725.2025.10.021
动脉导管未闭严重程度在胎龄≤32周早产儿肺出血发生和死亡中的预测价值
Patent ductus arteriosus severity predicts the occurrence and mortality of pulmonary hemorrhage in pre-mature infants with gestational age≤32 weeks
摘要
Abstract
Objective To evaluate the predictive value of patent ductus arteriosus(PDA)for the incidence and mortality of neonatal pulmonary hemorrhage(NPH)in infants with a gestational age(GA)of≤32 weeks.Methods Retrospective analysis of clinical data from premature infants with GA≤32 weeks consecutively admitted between January 2021 and June 2024.The analyzed clinical characteristics included GA,birth weight(WT),mode of delivery,diseases experienced by the infants,and maternal perinatal factors.Infants were categorized based on the presence or absence of NPH,and the clinical features of both groups were compared.Furthermore,infants with NPH and hemodynamically significant patent ductus arteriosus(hsPDA)were subdivided according to in-hospital mortality for additional analysis.Results The study included a total of 511 pediatric patients,of whom 92 cases were diagnosed with NPH.NPH was strongly correlated with mechanical ventilation(MV),high-frequency oscil-lation(HFO),hsPDA,disseminated intravascular coagulation(DIC),and intraventricular hemorrhage(IVH)(r=0.443,0.407,0.352,0.325,0.310,respectively;all P<0.001).Neonatal respiratory distress syndrome(NRDS)(grades 3-4),IVH,MV,HFO,DIC,and hsPDA were identified as independent risk factors for NPH in infants≤32 weeks of GA(OR=2.641,2.097,1.065,2.298,5.550,3.820,respectively;all P<0.05).GA,WT,PDA diameter,PDA velocity,left ventricular output(LVO),velocity of the late diastolic a'wave in the left ventricle(LV a'),and neonatal asphyxia(NA)were significant factors influencing NPH combined with hsPDA(all P<0.05).The PDA severity score(PDAsc)was determined to be a risk factor for mortality in infants≤32 weeks of GA with NPH and hsPDA(OR=1.265,95%CI 1.031-1.553,P=0.024).A strong correlation was observed between the predicted probability of death in infants with NPH and PDA and PDAsc(r=0.901,P=0.001).The ROC curve analysis demonstrated that PDAsc served as an ideal predictor of mortality in infants with NPH and PDA(AUC=0.687,P=0.002).Conclusions hsPDA is an independent risk factor for the development of NPH in infants≤32 weeks of GA.Additionally,PDAsc serves as a significant risk factor for mortality in infants≤32 weeks of GA who have both NPH and PDA,indicating a strong correlation and potential predictive value.关键词
动脉导管未闭/新生儿/肺出血/死亡/危险因素Key words
patent ductus arteriosus/neonate/pulmonary hemorrhage/death/risk factors分类
临床医学引用本文复制引用
江倩男,刘婷婷,刘莹莹,崔凯洁,刘秀香..动脉导管未闭严重程度在胎龄≤32周早产儿肺出血发生和死亡中的预测价值[J].实用医学杂志,2025,41(10):1575-1583,9.基金项目
山东省自然科学基金青年项目(编号:ZR2020QH054) （编号:ZR2020QH054）
青岛市科技惠民示范引导专项项目(编号:20-3-4-55-nsh) （编号:20-3-4-55-nsh）
青岛市卫生科技发展计划项目(编号:2019-WJZD129) （编号:2019-WJZD129）
