极早产儿和极低出生体重儿动脉导管未闭危险因素分析
Analysis of Risk Factors for Patent Ductus Arteriosus in Very Preterm and Very Low Birth Weight Infants

目的：研究极早产儿和极低出生体重儿动脉导管未闭的危险因素。方法：回顾性收集青岛大学附属烟台毓璜顶医院2019年1月~2022年12月收治的胎龄 < 32周的极早产儿或体重 < 1500 g的极低出生体重儿的临床资料，根据出生后5~7天内超声心动图结果分为PDA组(n = 263)和非PDA (nPDA)组(n = 262)。采用单因素分析和二元logistic回归分析探讨极早产儿和极低出生体重儿动脉导管未闭的危险因素。结果：单因素分析结果显示PDA的发生与胎膜早破、剖宫产、胎龄、体重、孕母合并糖尿病、产前使用糖皮质激素及抗生素、窒息、呼吸窘迫综合征、呼吸支持、气管插管、咖啡因及肺表面活性物质应用、白细胞计数、Apgar1分钟评分、Apgar5分钟评分有关(P < 0.05)。二元logistic回归分析结果显示胎膜早破、产前使用地塞米松、白细胞计数升高为PDA独立保护因素，出生时气管插管为独立危险因素(P < 0.05)。结论：尽早识别极早产儿和极低出生体重儿动脉导管未闭的危险因素，对实现极早产儿和极低出生体重儿动脉导管未闭的个体化管理有帮助。
Objective: To study the risk factors of patent ductus arteriosus in very preterm and very low birth weight infants. Methods: A retrospective collection of clinical data was conducted on very preterm infants with gestational age < 32 weeks or very low birth weight infants weighing < 1500 g who were admitted to Yantai Yuhuangding Hospital affiliated with Qingdao University from January 2019 to December 2022. The subjects were divided into two groups based on the ultrasound in the first 5 - 7 days after birth echocardiographic findings: the PDA group (263 cases) and the non-PDA (nPDA) group (262 cases). Univariate and binary logistic regression analyses were used to explore the risk factors of patent ductus arteriosus in very preterm and very low birth weight infants. Results: The results of univariate analyses showed that the occurrence of PDA was associated with premature rupture of membranes, cesarean section, gestational age, birth weight, maternal comorbidities with diabetes mellitus, prenatal use of glucocorticoids and antibiotics, asphyxia, respiratory distress syndrome, respiratory support, endotracheal intubation, caffeine and lung surfactant application, leukocyte counts, 1-minute Apgar score and 5-minute Apgar score (P < 0.05). Binary logistic regression analysis showed that premature rupture of membranes, antepartum use of dexamethasone, and elevated white blood cell counts are independent protective factors for PDA, and tracheal intubation at birth was an independent risk factor (P < 0.05). Conclusion: Identifying the risk factors for arterial ductus arteriosus in very preterm and very low birth weight infants as early as possible can help achieve individualized management of this condition.