足月新生儿呼吸窘迫综合征的诊断与治疗研究

Diagnosis and treatment of respiratory distress syndrome in full-term newborns

通过对我院足月新生儿监护病房2007年10月至2012年9月间收治的316例足月新生儿呼吸窘迫综合征（RDS）的临床资料进行调查分析,总结足月儿RDS的临床特点及诊治经验.结果表明足月儿RDS的主要临床特点是：男性多见;70.9％在生后3h内,90.2％在生后6h内,99.4％以上在12 h内发病.原发性RDS的主要诱因是选择性剖宫产,其次为男性患儿;宫内重症感染（肺炎/败血症）是继发性RDS的最常见原因,其次是出生时重度窒息和胎粪吸入综合征.病情重、进展快、易于导致持续胎儿循环和多器官系统功能衰竭,需呼吸机治疗的时间长.主要死亡原因是重症感染并发多脏器功能衰竭,诊断明确后及早给予机械通气治疗和使用“强力”抗生素控制感染是改善预后的关键.

To explore the pathogenesis,clinical characteristics and management strategies of respiratory distress syndrome （RDS） in full-term neonates.A total of 316 full-term infants with RDS were enrolled.The main characteristics of term ineonatal RDS are as following：Term neonatal RDS was more common in boys than in girls.70.9％ of the patients had an onset within 3 hours after birth,90.2％ of them within 6 hours after birth and 99.4％ of them within 12 hours after birth.The main causes of ARDS was selective cesarean section,followed by males; while severe infection was the most common cause of secondary RDS,followed by severe birth asphyxia and meconium aspiration syndrome.Illness state was more severe and evolved more rapidly.And it was more likely to develop into persistent pulmonary hypertension of newborn （PPHN） and multiple organ system failure （MOSF）,especially myocardial injuries and acute renal failure.Most patients required prolonged mechanical ventilation.The mortality was relatively higher and the major mortality cause was severe infection with MOSF.But their prognosis improved after comprehensive treatment measures including early mechanical ventilation and broad spectrum antibiotics were implemented.