足月新生儿呼吸衰竭368例临床分析及存活儿随访观察

Clinical analysis of neonatal respiratory failure in 368 term neonates and follow-up observation of the survivals

目的 探讨聊城市人民医院新生儿重症监护室（NICU）中足月新生儿呼吸衰竭（NRF）的临床特点,并随访观察气管插管常频机械通气后存活足月儿的生存质量.方法 选择2010年1月至2011年12月聊城市人民医院NICU收治的足月NRF患儿,均需呼吸机辅助通气,对NRF患儿的临床资料进行总结.并将其中行气管插管机械通气治疗存活的患儿,随访至出院后18个月,观察其体格生长、神经发育、呼吸道感染次数.结果 2年间该院NICU住院患儿中足月NRF共368例.（1）临床特点：①主要并发症：合并肾损害154例（41.8％）,持续肺动脉高压54例（14.7％）,合并气胸7例（1.9％）.②主要原发病：包括新生儿呼吸窘迫综合征（RDS）和（或）严重湿肺143例（38.9％）,新生儿肺炎102例（27.7％）,新生儿窒息72例（19.6％）.③预后：治愈244例（66.3％）,好转43例（11.7％）,死亡16例（4.3％）,放弃60例（17.7％）.④住院时间（12.1±0.3）d.（2）随访分析：368例NRF中,气管插管常频机械通气的足月新生儿共186例,治愈出院118例,其中有81例被随访至出院后18个月龄,随访率为68.6％.完全正常67例（82.7％）,不良神经预后14例（17.3％）,其中智力异常6例（7.4％）,运动异常8例（9.9％）,脑瘫1例,占1.2％,且同时伴有重度智力异常;语言障碍4例（5.0％）,听力异常1例（1.2％）.患肺炎12例（14.8％）.结论 足月儿NRF是该院NICU的重要疾病,可并发肾损害.足月儿NRF原发病以RDS和（或）严重湿肺为主.早期需气管插管机械通气的NRF新生儿是神经伤残的高危人群,易患肺部感染.

Objective To analyze the clinical characteristics of neonatal respiratory failure （NRF） in term neonates hospitalized in neonatal intensive care unit （NICU） of Liaocheng people＇s hospital,and to follow-up the quality of life in NRF term neonates who needed endotracheally intubated and normal frequency mechanical ventilation.Methods From January 2010 to December 2011 in NICU of Liaocheng people＇ s hospital,the clinical data of the NRF neonates who received mechanical ventilation were summarized at the same time.Physical development,neurological development and the times of respiratory infection of the survival NRF in term neonates who needed endotracheally intubated and normal frequency mechanical ventilation were followed up for 18 months after discharge.Results There were 368 cases of term neonates with NRF who received mechanical ventilation during admission from 2010 to 2011 in NICU.（1）Clinical features of NRF were：① Complications：154 cases（41.8%） with kidney injury,54 cases（14.7%） with pulmonary hypertension,7 cases （1.9%） with pneumothorax.② Etiology：Main primary diseases including 143 cases of neonatal respiratory distress syndrome （RDS） and （or） severe wet lung disease （38.9%）,102 cases of pneumonia （27.7%）,and 72 cases of asphyxia （19.6%）.③ Prognosis：244 neonates （66.3%） had complete recovery,43 neonates （11.7%） had clinical improvement,16 neonates （4.3%）deceased and 60 neonates（17.7%）with parental abandon of treatments.④ Hospitalization was （12.1 ± 0.3）d.（2） Follow up：Among all of the 186 cases of NRF in term neonates who needed endotracheally intubated and normal frequency mechanical ventilation,118 cases（63.4%） were cured,81 cases were followed up for 18 months after discharge.The follow-up rate was 68.6%.Sixty-seven cases（82.7%） were completely normal,14 cases （17.3%） were with adverse neurological outcome,in which 6 cases（7.4%） with mental abnormality,8 cases（9.9%） with abnormal movement,One case （1.2%） with cerebral palsy which was accompanied with severe mental abnormality;4 cases（5.0%） with language barrier,1 case （1.2%） with abnormal hearing.There were 12 cases（14.8%） with pneumonia.Conclusions Term NRF is one of the important diseases in NICU.Neonatal respiratory distress syndrome and severe wet lung of newborn were two leading causes that led to mechanical ventilation in term neonates.The term neonates who needed endotracheally intubated and normal frequency mechanical ventilation are the neuro-disability groups at high risk in NICU,who are susceptible to lung infections.