近足月儿呼吸衰竭的临床特征及预后分析

The respiratory distress syndrome clinical features and prognostic analysis of near-term infants

目的探讨近足月儿发生呼吸衰竭的病因、临床特征、治疗及预后,以提高近足月儿的救治率及减少伤残的发生。方法本研究选取2008年1月至2010年12月在我院新生儿科住院诊断为呼吸衰竭的新生儿524人为研究对象,近足月儿224例为观察组,对照组选取同期住院的呼吸衰竭的早期早产儿和足月儿。通过比较三组患儿的日龄、母孕期并发症、胎膜早破时间、分娩方式、1分钟Apgar评分、出生体重;应用持续气道正压通气(CPAP)例数、机械通气例数、肺表面活性物质使用例数、机械通气时间、住院天数;近期并发症如气漏、动脉导管未闭、颅内出血、持续肺动脉高压、脑室周围白质软化及预后情况。结果发生呼吸衰竭的病因近足月儿主要为湿肺和呼吸窘迫综合征,早期早产儿主要为呼吸窘迫综合征,足月儿以窒息、肺炎为主。并发症方面早期早产儿以颅内出血为主,近足月儿以气漏和持续肺动脉高压为主,足月儿以缺氧缺血性脑病为主。结论近足月儿与早期早产儿、足月儿相比,引起呼吸衰竭的病因与治疗方法及并发症方面不同,近足月儿发病率高,死亡率高,临床上应给予高度重视。

Objective： By observing the etiology, clinical characters, treatment and prognosis of on the near- term infants who were sufferting from severe neonatal respiratory distress syndrome （ NRDS）, we aim to improve the cure rate as well as decrease the morbidity of near - term infants NRDS. Methods ： This study selected 524 infants from January 2008 to December 2010 who were diagnosed respiratory distress as the object of study, and put the 224 near - term infant as observation group while the early preterm infants and term infants as two control groups, and compared the age, the Mother pregnancy complications,the premature rupture time of membrane, the delivery mode, the 1 rain apgar score, the birth weight, the ease numbers of applying CPAP, mechanical ventilation and pulmonary surfaetant, the hospital stays, the recent applications such as air leak, patent ductus arteriosus, intracranial hemorrhage, persistent pulmonary hypertension （ PPH）, periventrieular leukomalaeia and their prognosis. Results： Regarding the etiology of respiratory distress, it is mainly wet lung and NRDS for the nearterm infants, NRDS for the early preterm infants, asphyxia and pneumonia for the term infants . Regarding the complications, it is mainly intraeranial hemorrhage for the early preterm infants, air leak and PPH for the near-term infants, hypoxie isehemie eneephalopathy （HIE） for the term infants. Conclusion： Comparing to the early preterm infants and term infants, the nearterm infants have different etiology, therapeutic method and complications on respiratory distress. The near - term infants have higher morbidity and mortality, and should be attached with high attention clinically.