目的 探究极低出生体重（VLBW）儿肺出血预后的重要影响因素。方法 回顾性分析2018年1月1日至2021年12月31日NICU收治的肺出血VLBW儿的临床资料。结果 64例VLBW新生儿纳入分析，死亡组39例、存活组25例。39例死亡患儿中，胎龄<28周21例、28~31⁺⁶周17例、32~33⁺⁶周1例；出生体重<1 000 g17例、1 000~1 250 g13例、1 250~1 500 g9例。与存活组相比，死亡组出生体重和出生胎龄较小，肺出血发生日龄较小，出生胎龄<28周以及气管插管复苏的比例较高，Ⅲ~Ⅳ级呼吸窘迫综合征、症状性动脉导管未闭、早发型败血症的比例较高，差异均有统计学意义（P<0.05）；与存活组相比，死亡组生后24 h内气道峰压较高，肺出血前吸入氧浓度较高，肺出血后吸入氧浓度和气道峰压较高；出生后动脉血碱剩余<-5 mmol/L的比例较高，肺出血时动脉血pH值<7.1、碱剩余<-5 mmol/L、PaCO₂>50 mmHg的比例较高；肺出血时凝血酶原时间（PT）和凝血酶时间延长，差异均有统计学意义（P<0.05）。二分类logistic回归分析显示，气管插管复苏和肺出血时PT≥30 s是肺出血患儿死亡的独立危险因素（P<0.05）。Log-rank检验发现气管插管复苏组中位生存时间短于非复苏组，PT≥30 s组中位生存时间短于PT<30 s组，差异有统计学意义（P<0.001）。结论 临床中需注重VLBW儿宫内缺氧情况，出生后合理应用气管插管复苏，积极纠正出血后凝血功能障碍，从而减少肺出血病死率。

Objective To explore the important prognostic factors of pulmonary hemorrhage in very low birth weight (VLBW) infants. Methods The clinical data of VLBW infants diagnosed with pulmonary hemorrhage admitted to NICU from January 1, 2018 to December 31, 2021 were retrospectively analyzed. Results A total of 64 VLBW neonates were included, 39 in the death group and 25 in the survival group. In the death group, there were 21 neonates with gestational age <28 weeks, 17 with gestational age of 28-31⁺⁶ weeks, and 1 with gestational age of 32-33⁺⁶ weeks. There were 17 neonates with birth weight <1000 g, 13 with 1000-1250 g, and 9 with 1250-1500 g. Compared with the survival group, the death group had lower birth weight and gestational age, lower age of pulmonary hemorrhage occurrence, higher rates of gestational age <28 weeks and resuscitation by tracheal intubation, and higher rates of Ⅲ-Ⅳ respiratory distress syndrome, symptomatic ductus arteriosus and early-onset sepsis, with statistical significance (P<0.05). Compared with the survival group, the death group had higher peak inspiratory pressure within 24h after birth, higher fraction of inspired oxygen before pulmonary hemorrhage, and higher fraction of inspired oxygen and peak inspiratory pressure after pulmonary hemorrhage; In the death group, the proportion of arterial blood BE<-5mmol/L after birth was higher, and the proportion of arterial blood pH<7.1, BE<-5 mmol/L, PaCO₂>50 mmHg was higher when pulmonary hemorrhage occurred; Prothrombin time (PT) and thrombin time were prolonged during pulmonary hemorrhage in the death group. The differences were statistically significant (P<0.05). Binary logistic regression analysis showed that resuscitation by tracheal intubation and PT≥30 s during pulmonary hemorrhage were independent risk factors for death in children with pulmonary hemorrhage (P<0.05). Log-rank test showed that the median survival time in the resuscitation group was shorter than that in the non-resuscitation group, and the median survival time in the PT≥30 s group was shorter than that in the PT<30 s group, the difference was statistically significant (P<0.001). Conclusions In clinical work, attention should be paid to the intrauterine hypoxia of VLBW infants, the reasonable application of tracheal intubation resuscitation after birth, and the active correction of coagulation dysfunction after bleeding, so as to reduce the mortality of pulmonary hemorrhage.