新生儿窒息复苏后发生持续肺动脉高压的相关因素分析

Correlation analysis of risk factors for persistant pulmonary hypertension after resuscitation in neonatal asphyxia

目的 分析新生儿窒息复苏后发生新生儿持续肺动脉高压（PPHN）的相关危险因素.方法 2009年1月至2013年12月首都医科大学附属北京儿童医院收治的新生儿窒息患儿中发生PPHN的92例为PPHN组.根据患儿情况,以病例-对照研究方法选取同期无PPHN的新生儿窒息患儿92例为对照组.除外由于其他严重并发症,如呼吸窘迫综合征、胎粪吸入、肺出血、新生儿重症肺部感染、膈疝等引起的肺动脉高压.通过查阅新生儿围生期调查表对所有患儿记录Apgar评分、抢救措施、入院时动脉血气分析,同时监测体温、血糖、床边超声心动图.结果 PPHN组在复苏抢救过程中需要积极呼吸支持治疗71例（77.2％）,对照组患儿为28例（30.4％）,差异有统计学意义（χ2=6.380,P=0.012）.入院时PPHN组的平均动脉血压[（32.36±11.52） mmHg（1 mmHg=0.133 kPa）]、体温[（34.3±0.28）℃]、血糖[（2.56 ±0.77） mmol/L]及动脉血pH值（7.16±0.21）均低于对照组[（38.55 ±9.18） mmHg、（36.5±0.71）℃、（3.46 ±0.53） mmol/L、7.21±0.14].PPHN组中轻度窒息及重度窒息患儿在经过院外复苏抢救处理后,入院时血气分析及肺动脉高压严重程度差异无统计学意义.结论 新生儿窒息复苏后酸中毒、低体温、低血压、低血糖为发生PPHN的主要危险因素.早期及时正确复苏处理后进行有效的呼吸支持、密切监护、对症治疗低血糖、低体温,纠正酸中毒及维持血压可有效减少PPHN的发生.

Objective To analyze of the risk factors for persistent pulmonary hypertension of newborn（PPHN） after resuscitation in neonatal asphyxia.Methods Total 92 cases of PPHN in neonatal asphyxia were admitted in NICU,Beijing Children＇s Hospital Affiliated to Capital Medical University from Jan.2009 to Dec.2013 as PPHN group.According to patients condition,to case-control study method were randomly selected 92 cases without PPHN in neonatal asphyxia in the same period as control group.Except for other serious complications with PPHN,such as respiratory distress syndrome,meconium inhalation,pulmonary hemorrhage,neonatal severe pulmonary infection and diaphragmatic hernia.Apgar score and rescue measures after asphyxia based on the newborn perinatal questionnaire and body temperature,blood sugar,arterial blood gas and echocardiography on admission were recorded.Results Respiratory treatment of PPHN group and control group were 71 cases （77.2%） vs 28 cases （30.4%）,respectively.There was significant difference （χ2 =6.380,P =0.012）.On admission,mean arterial pressure [（32.36 ± 11.52） mmHg],temperature [（34.3 ±0.28） ℃],blood sugar [（2.56 ±0.77） mmol/L] and arterial blood pH value （7.16 ±0.21） in PPHN group were lower than those of the control group [（38.55 ± 9.18） mmHg,（36.5 ± 0.71） ℃,（3.46 ± 0.53） mmol/L,7.21 ±0.14].For mild and severe asphyxia cases in the PPHN group,blood gas and pulmonary hypertension had no statistical difference after rescucitation in the delivery hospital.Conclusions Acidosis,hypothermia,low blood pressure and hypoglycaemia after resuscitation in neonatal asphyxia are major risk factors for genesis of PPHN.This research shows that rescue after asphyxia timely,early and respiratory support effectively,monitoring closely,treatment of hypoglycemia and hypothermia,correct acidosis and maintain blood pressure can play a positive role in decreasing the morbidity of PPHN in neonatal asphyxia.