Analysis of influencing factors of blood transfusion complications in very low birth weight infants
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摘要: 目的 研究输血对极低岀生体重儿(VLBWI)常见并发症发病率的影响因素分析。方法 选取医院新生儿重症监护病房2020年1月1日—2022年12月31日期间住院治疗的361例VLBW患儿作为研究对象，其中输注去白细胞悬浮红细胞的VLBW患儿324例(输血组)，未输血患儿37例(未输血组)。回顾性分析输血对患儿并发症的影响，比较输血组与未输血组VLBWI常见并发症发病率的差异，分析首次输血时间、输血次数对VLBWI并发症的影响及输血相关坏死性小肠结肠炎(NEC)的危险因素。结果 输血组与未输血组VLBWI比较，输血组支气管肺发育不良(BPD)、NEC、脑室出血(IVH)、新生儿败血症发病率显著高于未输血组(P < 0.05)。VLBWI输血后BPD、NEC、早产儿视网膜病变(ROP)发病率分别为72.53%、18.21%、15.74%。VLBWI早期输血组(首次输血时间在出生2周内)BPD、NEC、ROP、新生儿喂养不耐受发生率显著高于晚期输血组(首次输血时间在出生2周后)(P < 0.05)，而新生儿败血症发生率差异无统计学意义(P>0.05)。VLBWI输血≥3次组BPD、NEC、ROP、IVH、新生儿喂养不耐受、新生儿败血症发病率显著高于输血 < 3次组(P < 0.05)。多因素logistic回归分析显示，输血次数是NEC的独立危险因素(OR=1.211，95%CI 1.017~1.444，P=0.032)。结论 VLBWI相关并发症发生可能与输血有关，首次输血时间越早、输血次数越多，相关并发症发病率越高。应减少早期输血和输血次数，从而降低相关并发症的发生。Abstract: Objective To study the influence and factor analysis of blood transfusion on the incidence of common complications in very low birthweight infants(VLBWI).Methods A total of 361 VLBW children hospitalized in the neonatal intensive care unit from January 1, 2020 to December 31, 2022 were selected as the study subjects, including 324 VLBW children who received leucocyte suspended red blood cells(transfusion group) and 37 children who did not receive transfusion(non-transfusion group). The effects of blood transfusion on the complications of children were retrospectively analyzed, and the differences in the incidence of common complications of VLBWI between the transfusion group and the non-transfusion group were compared. The effects of the time of first transfusion and the number of transfusion on the complications of VLBWI and the risk factors of transfusion-related necrotizing enterocolitis(NEC) were analyzed.Results The incidence of bronchopulmonary dysplasia(BPD), NEC, ventricular hemorrhage(IVH) and septicemia in VLBWI transfusion group was significantly higher than that in non-transfusion group(P < 0.05). The incidence of BPD, NEC and retinopathy of prematurity(ROP) after VLBWI transfusion were 72.53%, 18.21% and 15.74%, respectively. The incidence of BPD, NEC, ROP and neonatal feeding intolerance in VLBWI early transfusion group(the first transfusion was within 2 weeks of birth) was significantly higher than that in late transfusion group(the first transfusion was after 2 weeks of birth)(P < 0.05), while the incidence of neonatal sepsis was not statistically significant(P>0.05). The incidence of BPD, NEC, ROP, IVH, neonatal feeding intolerance and sepsis in ≥3 VLBWI transfusion group were significantly higher than those in < 3 transfusion group(P < 0.05). Multivariate logistic regression analysis showed that the number of transfusions was an independent risk factor for NEC(OR=1.211, 95%CI 1.017-1.444, P=0.032).Conclusion The incidence of VLBWI related complications may be related to blood transfusion. The earlier the first transfusion time and the more transfusions, the higher the incidence of related complications. Early blood transfusion and the number of transfusions should be reduced to reduce the occurrence of related complications.
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Key words:
- very low birth weight infants /
- blood transfusion /
- complication
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表 1 VLBWI输血组与未输血组临床资料及并发症比较
观察指标 输血组(n=324) 未输血组(n=37) Z/χ2 P 男/例(%) 167(51.54) 15(40.54) 1.601 0.206 胎龄/周 29(28，30) 32(30，33) 6.663 < 0.001 出生体重/g 1 240(1 100，1 350) 1 350(1 250，1 450) 4.438 < 0.001 1 min Apgar评分/分 8(8，8) 8(8，9) 3.292 0.001 5 min Apgar评分/分 9(9，9) 9(9，10) 3.239 0.001 有创通气时间/d 2(1，4) 0 5.784 < 0.001 呼吸机通气时间/d 28.00(16.75，38.00) 15.00(10.00，23.00) 4.240 < 0.001 混合用氧时间/d 40(27，48) 8(5，11) 7.991 < 0.001 总用氧时间/d 43.5(33.0，51.0) 23.0(17.0，28.0) 3.941 < 0.001 住院天数/d 53.00(44.00，68.75) 34.00(27.50，38.00) 7.555 < 0.001 BPD/例(%) 235(72.53) 7(18.92) 43.193 < 0.001 NEC/例(%) 59(18.21) 1(2.70) 5.762 0.016 ROP/例(%) 51(15.74) 2(5.41) 2.832 0.092 IVH/例(%) 32(9.88) 0 4.010 0.045 新生儿喂养不耐受/例(%) 81(25.00) 8(21.62) 0.204 0.651 新生儿败血症/例(%) 98(30.25) 1(2.70) 12.658 < 0.001 
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表 2 VLBWI早期输血组与晚期输血组输血后并发症的比较
观察指标 早期输血组(n=198) 晚期输血组(n=126) t/χ2 P 首次输血时间/d 6.73±4.26 21.38±5.48 4.928 < 0.001 输血前Hb/(g/L) 110.18±10.90 101.28±9.00 5.503 < 0.001 BPD/例(%) 154(77.78) 81(64.29) 7.035 0.008 NEC/例(%) 46(23.23) 13(10.32) 8.623 0.003 ROP/例(%) 39(19.70) 12(9.52) 6.008 0.014 新生儿喂养不耐受/例(%) 60(30.30) 21(16.67) 7.636 0.006 新生儿败血症/例(%) 66(33.33) 32(25.40) 2.299 0.129
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表 3 输血次数对VLBWI并发症的影响
例(%) 疾病发生率 输血 < 3次(n=143) 输血≥3次(n=181) χ2 P BPD 81(56.64) 154(85.08) 32.430 < 0.001 NEC 15(10.49) 44(24.30) 10.781 0.001 ROP 10(6.99) 41(22.65) 13.033 < 0.001 IVH 8(5.59) 24(13.26) 5.273 0.022 新生儿喂养不耐受 24(16.78) 57(31.49) 9.217 0.002 新生儿败血症 24(16.78) 74(40.88) 21.990 < 0.001
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表 4 影响NEC发病率的因素分析
观察指标 NEC组(n=59) 非NEC组(n=265) t/Z P 胎龄/周 28.75±2.01 29.34±1.76 2.164 0.031 出生体重/g 1 200(1 095，1 315) 1 250(1 100，1 360) 1.319 0.187 住院天数/d 61(46，81) 53(43，67) 2.303 0.021 输血前Hb/(g/L) 103.84±12.96 105.80±11.24 1.065 0.288 输血前HCT/% 30.85±3.72 31.45±3.71 0.972 0.332 首次输血时间/d 8.68(3.12，14.85) 12.00(5.64，18.52) 1.906 0.057 红细胞储存时间/d 14.03(8.93，24.21) 17.02(13.10，22.87) 1.460 0.144 输血次数/次 4.00(2.75，5.00) 3.00(2.00，4.00) 4.274 < 0.001
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表 5 影响NEC发病率的多因素logistic回归分析
变量 相关系数 SE Wald P OR 95%CI 常量 -1.716 3.150 0.297 0.586 0.180 — 胎龄 -0.024 0.101 0.058 0.809 0.976 0.080~1.189 住院天数 0.002 0.010 0.034 0.854 1.002 0.982~1.023 输血次数 0.192 0.089 4.596 0.032 1.211 1.017~1.444
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