足月儿与早产儿呼吸窘迫综合征发病临床比较分析

Comparison of the Clinical Characteristics of Newborn Respiratory Distress Syndrome between Full-term and Premature Infants

目的比较足月新生儿与早产儿呼吸窘迫综合征发病的临床特点,以进一步探讨两者发病的异同之处.方法将2007年1月至2010年8月在昆明市幼保健院新儿科重症监护室临床确诊为呼吸窘迫综合征的86例不同胎龄新生儿分为两组,即早产儿组50例(<37周)和足月儿组36例(>37周),就其病因、发病时间、X线表现、治疗及并发症进行临床对比回顾性分析.结果足月儿病因为胎粪吸入性肺炎、窒息、剖宫产等.早产儿为早产、胎膜早破、窒息、剖宫产、吸入性肺炎.足月儿在生后(10.5±4.1)h出现进行性呼吸困难,青紫;机械通气时间(97.7±17.2)h.早产儿在生后(3.9±2.7)h出现进行性呼吸困难、呻吟、青紫;机械通气时间(79.7±7.6)h;两组X线胸片均可见双肺有弥漫性浸润影,可见支气管充气征;足月儿呼吸窘迫综合征大多合并原发病征象.结论足月儿出现呼吸窘迫综合征的时间比早产儿要晚、机械通气时间要长,胎粪吸入性肺炎、窒息、剖宫产是其高危因素;早产儿以肺表面活性物质生成能力不足为主.

Objective To compare the clinical characteristics of newborn respiratory distress syndrome between full term and premature infants, and to further explore the similarities and differences between them. Methods Eighty six cases of confirmed respiratory distress syndrome with different gestational age in ICU of the department of Newborn in our hospital from January, 2007 to August, 2010, were enrolled in this study. They were divided into two groups： the premature infant group （50 cases, 〈 37 weeks） and the full term group （36cases, 〉 37 weeks）. The cause of disease, the onset time, X ray performance, the treatment and complications of them were analyzed retrospectively. Results The causes of disease in full term infants were the meconium aspiration pneumonia, asphyxia, cesarean section and so on. The causes of disease in premature infants were premature delivery, premature rupture of memberane, asphyxia, cesarean section and aspiration pneumonia. Progressive dyspnea and cyanosis appeared in full term infants （10.5 ±4.1 ） h after birth, the mechanical ventilation time was （97.7 ± 17.2） h. While Progressive dyspnea, groaning and cyanosis appeared in premature infants （3.9 ±2.7） h after birth, the mechanical ventilation time was （79.7 ±7.6） h. The chest X ray of infants in the two groups showed obvious diffused infiltrating shade in double lungs and air bronchogram. Most full term infants with respiratory distress syndrome were complicated with the protopathy signs.Conclusions The incidence of respiratory distress syndrome is later, and the mechanical ventilation time was longer in full term infants than in premature infants. Meconium aspiration pneumonia, asphyxia, and cesarean section are high risk factors of respiratory distress syndrome in full term infants, while insufficient generative capacity of pulmonary surfactant is the high risk factor in premature infants.