足月与近足月新生儿呼吸窘迫综合征临床分析

Clincal Anlysis on Respiratory Distress Syndrome in Term and Near-Term Neonatus

目的:探讨足月与近足月新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)的临床特点,加强认识,提高救治成功率。方法:回顾自2009年1月至2012年4月我院NICU收治的NRDS共112人,其中足月与近足月新生儿NRDS 60例,均出现呼吸困难、给予呼吸机辅助通气或联合肺表面活性药物(PS)治疗。对其临床资料进行回顾性分析。结果:20例Ⅱ型呼衰患儿,给予呼吸机或联合PS治疗,18人治愈,2人放弃;40例I型呼衰患儿,给予鼻塞正压通气或联合PS治疗,27例治愈,另13例改为有创呼吸机,治愈8例,放弃5例。60例中同时并发肺动脉高压12例。结论:足月及近足月新生儿NRDS发病率逐渐升高,尤其是选择性剖宫产儿。起病较晚,更易出现新生儿持续肺动脉高压(PPHN)等严重并发症,死亡率较高,治疗原发病及早期机械通气联合PS治疗,加强防治可提高救治成功率。

Objective： To investigate the clinical characteristics of term and near-term neonatal respiratory distress syndrome, enhance cognize, improve cure successful rate. Methods： We retrospectively analysed 112 neonatus respiratory distress syndrome in our NICU from January 2009 to April 2012. include 60 cases of term and near-term neonatal respiratory distress syndrome,who were treated with mechanical ventilation or combined with pulmonary surfactant drug. Results：In 20 cases of type Ⅱ respiratory failure in children,18 cases were cured with respirator or a combined PS and 2 cases were gave up treatment. In 40 cases of children with type I respiratory failure, there are all given the nasal positive airway pressure or combined with PS therapy. 27 cases were cured,but the other 13 eases（ include in 40 cases ） to the invasive mechanical ventilation-8 cases were cured and 5 eases were gave up treatment. There are 12 eases with pulmonary hypertension in 60 cases. Conclusion：Term and nearly full-term newborn NRDS gradually increased incidence, espeeilly in selective cesarean section. Symptoms of late cases, the neonatus tend to show neonatal persistent pulmonary hypertension （ PPHN）, other seri- ous complications and high mortality rate. Treatment of the primary disease and early mechanical ventilation combined with PS treatment, strengthen prevention and treatment can improve the success rate of treatment. In order to important to improve the successfuU rate of treatment,it is necessary to treat the primary disease and early mechanical ventilation combined with PS treatment.