新生儿肺出血的病因分析

Pathogenesis of neonatal Pulmonary hemorrhage

目的探讨新生儿肺出血病因。方法选择1958年5月至2004年4月46年期间,我院新生儿肺出血死亡病例788例,将肺出血按不同病理表现分为点状肺出血、局灶性肺出血及弥漫性肺出血,以此进行临床与病理诊断资料统计,并结合发病机制做进一步分析、明确肺出血病因。结果本组每例肺出血患儿均有多种疾病共存,临床与病理诊断不完全相符,但两者所涉及的疾病诊断内容基本一致,共归类出"缺氧因素"、"感染因素"及"其他因素"3大类21种病变。再根据肺出血发病机制将16项肺出血病因分为"缺氧因素"共10项388例(49·24%),以寒冷损伤及吸入性肺炎为多;"感染因素"共6项400例(50·76%),以感染性肺炎为多。在归类为"其他因素"共5项中,包括最常见的早产,均合并有缺氧或感染,无1例因单纯早产而导致肺出血者。结论结合上述3类因素,认为可明确证实的病因有寒冷损伤、围产期缺氧及严重感染。须进一步探讨的病因有机械通气不当、外源性肺表面活性物质应用、氧中毒、孕母患妊娠期高血压疾病。可排除为肺出血的病因有早产、急性心力衰竭、高黏滞血症或红细胞增多症、弥漫性血管内凝血及核黄疸。

Objective To investigate the causal agents of neonatal pulmonary hemorrhage （NPH）. Methods Selected 788 autopsied cases died from NPH since May,1958 to April, 2004. The pathologic features of NPH were divided into 3 types： petechial pulmonary hemorrhage, focal pulmonary hemorrhage and diffuse pulmonary hemorrhage. The causal agents of NPH were anelyzed pathologically and chnically. Results Each case of NPH had complicated other different disease, so that there were some incomplete coincidences between clinic and pathologic diagnosis, but the contents of diagnosis both in clinic and pathologic diagnosis were coincided basically. There were 21 kinds of diagnosis surveyed. According to the pathogenesis, the causal agents were divided into 3 major causal factors： hypoxia, infection and others. As the causal agent of NPH, hypoxia included 10 items total 388 cases （49. 24% ）, cold injure and aspiration pneumonia were the most common incidences in this group. There were 6 items total 400 cases （50. 76% ） in infectious group. The chief disease was infectious pneumonia. Other factors group included 5, items the most important cause was premature delivery, all of them died from hypoxia or infection but not only from NPH. Conclusions Among the many causal agents of the death in NPH, the clear causal agents are cold injure, hypoxia and serious infection. The possible causal agents are incorrect mechanical ventilation, exogenous pulmonary surfactant replacement, oxygen intoxication, hypertensive disorder complicating pregnancy. The following causal factors could be excepted： premature delivery, acute heart failure, polycythemia or hyperviscosity syndrome. Disseminated intravascular coagulations and nuclear jaundice.