新生儿呼吸衰竭870例临床流行病学分析

Clinical analysis of neonatal respiratory failure in 870 infants

目的探讨聊城市人民医院新生儿重症监护室(NICU)中不同胎龄新生儿呼吸衰竭(NRF)的临床特点,为合理诊治提供依据。方法选择2010—2011年我院NICU收治的NRF患儿,根据胎龄分为≤32周组、33～36周组和≥37周组,对各组新生儿的围产期情况、疾病分布状况、呼吸机辅助通气方式、通气时间、辅助通气并发症、住院时间、费用及预后进行回顾性总结,以反映我院NICU新生儿呼吸危重病的救治状况。结果 2年间我院NICU共收治新生儿3077例,NRF870例,占同期住院患儿的28.3%;主要原发疾病包括新生儿呼吸窘迫综合征(RDS)和(或)严重湿肺398例(45.7%),新生儿肺炎224例(25.7%),新生儿窒息163例(18.7%)。870例患儿中,早产儿502例,占57.7%;痰培养阳性157例,占18.0%;合并持续肺动脉高压99例(11.4%),合并气胸14例(1.6%);治愈558例(64.1%),好转105例(12.1%),死亡47例(5.4%),放弃160例(18.4%);住院时间(14.2±8.8)天。结论 NRF是本院NICU的重要疾病,原发病以RDS和(或)严重湿肺为首,足月儿RDS有增多趋势,与择期剖宫产、羊水污染有关,容易并发持续肺动脉高压,应引起重视。开展针对早产儿及RDS救治的新技术有利于提高NRF的救治成功率,降低病死率。

Objective To analyze clinical features of neonatal respiratory failure （NRF） in infants of different gestational age for improvement of future managements of patients. Methods Neonates with NRF who received mechanical ventilation during NICU admission from 2010 to 2011 in our hospital were divided into 3 groups （ ≤ 32 weeeks, 33 - 36 weeks, and ≥ 37 weeks） according to gestational age. Retrospective analyses were conducted on perinatal and prenatal data, disease distribution, method and duration of mechanical ventilation, complications, length and cost of hospitalization, and prognosis of these patients. Results In 3077 infants admitted to NICU, 870 （28.3%） neonates required mechanical ventilation. Clinical features of NRF are： （ 1 ） Etiology： There were 398 （45.7%） cases of RDS or severe wet lung disease, 224 cases of pneumonia （25.7%）, and 163 cases of asphyxia （ 18.7% ） ; （2） Gestational age at the time of delivery： there were 502 （57.7%） premature infants; （3） Laboratory findings： 157 （18.0%） neonates had positive sputum culture; （4） Complications： 99 （ 11.4%. ） neonates had persistent pulmonary hypertension and 14 （ 1.6% ） neonates had pneumothorax; （ 5 ） Prognosis： 558 neonates （ 64. 1% ） had complete recovery, 105 neonates（12. 1% ） had clinical improvement, 47 neonates （5.4%） deceased and 160 neonates（18,4%） with parental abandon of treatments ; （6） Duration of hospitalization was ranged from 14. 2 - 8.8 days. Conclusions Neonatal respiratory distress syndrome and severe wet lung of newborn were two leading causes that lead to mechanical ventilation in neonates. Increased incidences of RDS and persistent pulmonary hypertension observed in term neonates may be related to elective cesarean section and amniotic fluid contamination.