摘要
目的分析不同胎龄新生儿呼吸窘迫综合征(RDS)的临床特征。方法将2013年1月至2017年1月期间在陕西省人民医院及西安市北方医院新生儿科住院治疗的145例RDS患儿根据胎龄分为早期早产组(胎龄<34周,n=70)、晚期早产组(胎龄34~37周,n=35)、足月产组(胎龄>37周,n=40),回顾分析并比较产妇孕期的情况及患儿出生情况。结果胎龄<34周的患儿占48.3%(70/145),34~37周的占24.1%(35/145),>37周的占27.6%(40/145)。早期早产组的患儿产前皮质激素使用率明显高于晚期早产组及足月产组(χ2值分别为6.61、25.79,均P<0.05),而ALB水平明显低于足月产组(q=9.80,P<0.05),伴有原发病的患儿比例明显低于足月产组(χ2=11.39,P<0.01)。两两比较发现,早期早产组出现呼吸困难的时间明显早于晚期早产组及足月产组,差异有统计学意义(q值分别为2.77、2.81,均P<0.05),但三组pH、氧分压与吸入氧浓度比值(PaO_2/FiO_2)比较差异均无统计学意义(均P>0.05)。足月产组和晚期早产组的肺表面活性物质(PS)重复使用率明显高于早期早产组(χ~2值分别为7.54、4.97,均P<0.05);足月产组持续气道正压通气(CPAP)使用率明显高于晚期早产组(χ~2=7.44,P<0.05),高频震荡通气(HFOV)使用率明显高于早期早产组(χ~2=6.89,P<0.05);早期早产组脑室内出血(IVH)的发生率明显高于晚期早产组及足月产组(χ~2值分别为4.25、7.34,均P<0.05)。结论不同胎龄新生儿RDS发生的主要机制都是肺表面活性物质缺乏,但均具有各自的临床特征,治疗方法亦应有差别。
Objective To analyze the clinical characteristics of respiratory distress syndrome （RDS） in neonates with different gestational age. Methods Altogether 145 neonates with RDS hospitalized in neonatal department in Shaanxi People＇s Hospital and Xi＇an Northern Hospital from January 2013 to January 2017 were divided into early preterm birth group （gestational age〈34 weeks, n=70）, late preterm birth group （gestationaI age 34-37 weeks, n 35）, and full term birth group （gestational ageD37 weeks, n= 40） according to different gestational age. Pregnancy conditions of puerpera and neonatal situation at birth were retrospectively analyzed and compared. Results Neonates with gestational age %34 weeks accounted for 48.3% （70/145）, 34 37 weeks accounted for 24.1% （35/145） and 〉37 weeks 27.6% （40/145）. Antenatal corticosteroids supplementation in early preterm birth group was obviously more than that in late preterm birth group and full term group （χ2early p birth group vs late I birth group = 6.61, P〈0.05 ;χ2early preterm birth group vs full birth group = 25.79, P 〈0.05）, and ALB level in early preterm birth group was significantly lower than that in full-term group （qearlyt birtb group w fun birth group =9.80, P〈0.05）, and proportion of neonates with primary disease in early prelerm birth group was lower than that in full - term group （ χ2early preterm birth group vs full-termbirth group = 11.39, P 〈 0.01 ）. Pairwise comparison showed that dyspnea occurring time in early preterm birth group was significantly earlier than that in late preterm birth group and full-term group, and the difference had statistical significance （qearlyt birth group vs late preterm birth group = 2. 77, qcarly preterm birth group vs full birth group = 2.81, both P〈0.05）, but the differences in pH, ratio of oxygen partial pressure and fraction of inhaled oxygen （PaO2/FiO2 ） among three groups were not statistically significant （all P 〉0. 05）. Pulmonary surfactant （PS） repeat utilization rate in late preterm birth group and full-term group was significantly higher than that in early preterm birth group （χ2 full term birth group vs carly preterm birth group = 7.54, χ2full-term birth group vs late p birth group = 4.97, both P 〈0.05 ）. Continuous positive airway pressure （（;PAP） utilization rate in full term group was significantly higher than that in late preterm birth group （χ2fullterm birth group vs late preterm birth group = 7.44, P〈0.05 ）, and high frequency oscillation ventilation （HFOV） utilization rate in full term group was significantly higher than that in early preterm birth group （ χ2full-term birth group vs early preterm birth group=6.89, P 〈 0. 05）. ）. full tern1 blrtb group vs early preterm birth group - Intraventricular hemorrhage （IVH） incidence in early preterm birth group was obviously higher than thai in late preterm birth group and full-term group （ χ^2early preterm birth group vs late preteral birth group = 4. 25, χ^2 early p birth group vs full term birth group = 7. 34, both P〈 0.05 ）. Conclusion Main pathogenesis of RDS in neonates with different gestational age is defect of pulmonary surfactant, but clinical characteristics of neonatal RDS in different gestational age are different, and treatment methods also have differences.
作者
李雪瑞
芦红茹
LI Xue rui;LU Hong-ru(Neonatal Department, Xi ＇an Northern Hospital, Shaanxi Xi ＇an 710043, China;Neonatal Department, Shaanxi People＇s Hospital, Shaanxi Xi ＇an 710068, China)
出处
《中国妇幼健康研究》
2018年第5期606-609,共4页
Chinese Journal of Woman and Child Health Research
关键词
新生儿呼吸窘迫综合征
胎龄
临床特征
回顾性分析
neonatal respiratory distress syndrome
gestational age
clinical characteristics
retrospective analysis
