新生儿围产期重度窒息与多器官功能衰竭

Severe perinatal asphyxia and multiple organ failure.

目的 探讨新生儿窒息致多系统器官功能衰竭(MOF)的发病机制,高危因素及防治的关键问题。方法分析于出生48h内发生MOF的107例重度窒息儿临床资料。结果 本组患儿均有肺功能衰竭,都以肺功能衰竭或包括肺的功能衰竭器官群首发;患儿病死率;受累器官为2、3、4、5个以上组分别是22.2％、52.2％、77.8％、100.0％,出生胎龄为-28w,-不足37、37w以上组分别是66.7％、44.4％、24.6％,生后发生MSOF时间为～12h、～24h、～48h组分别是46.5％、34.2％、19.3％。结论 受累脏器愈多,胎龄愈小,MOF发生愈早,其病死率愈高。尽早处理宫内窘迫及有效复苏,阻断肺动脉高压造成的恶性循环,是防止继发其他功能衰竭的关键。

Objective: To study pathogeny, the high nsk factor and key prevention and treatment oi multiple organ failure (MOF) . Methods: 107 cases of several perinatal asphyxia with MOF developed during 48h after birth were analyzed. Results: All of the patients were suffered from lung failure, which was also the first symptom. Mortaity depended on severer factors. As the numbers of the affected organs was 2,3,4 and 5 or more,the mortality was reapectively 22.2% ,52.2% ,77.8% and 100% .The gestation age was - 28, - 37 and 37weeks,the corresponding mortality was 66.7% ,44.4% and 24.6% .And if the MOF happened within - 12h, - 24h and - 48h after birth, the mortality is 46.5% , 34.2% and 19.3% . Conclusion: The more affeced organs,the younger gestation age and earlier MOF cause a higher morality.The key way to prevent organs from developing secondary function failure is to treat intrauterine fetal distress as soon as possible,succeeded resuscitation,and to stop the vicious circles cause by pulmonary artery high pressure.