西北地区三级医院不同胎龄新生儿呼吸窘迫综合征疾病特点和防治状况研究

Clinical features, prevention and treatment of respiratory distress syndrome in neonates of different gestational ages in tertiary hospitals in Northwest China

目的调查西北地区三级医院不同胎龄新生儿呼吸窘迫综合征（RDS）的疾病特点和防治状况,为西北地区RDS的防治提供依据。方法将2011年1月至12月西北三省12家三级医院诊断为RDS的新生儿440例分为早期早产儿组（胎龄〈34周,n=247）、晚期早产儿组（胎龄34～36^＋6周,n=131）和足月儿组（胎龄≥37周,n=62）,收集各组患儿发病基本情况、围产因素、防治情况、并发症及预后等进行回顾性分析。结果早期早产儿组多胎率最高;两个早产儿组胎膜早破发生率高于足月儿组;足月儿组无宫缩剖宫产率高于两个早产儿组。产前激素应用率以早期早产儿组最高;早期早产儿组肺表面活性物质（PS）的使用率及首次应用时间均高于其余两组（P〈0.05）;足月儿组产房开展复苏率低于其余两组（P〈0.05）。早期早产儿组动脉导管未闭（PDA）及颅内出血的发生率均为最高;RDS治愈率以足月儿组最高（78.2%）,晚期早产儿组次之（58.6%）,早期早产儿组最低（42.9%）（P〈0.05）。结论西北地区不同胎龄RDS患儿在围产期因素、产前预防、PS治疗、并发症及预后等方面有明显不同。

Objective To investigate the clinical features, prevention and treatment of respiratory distress syndrome（RDS） in neonates of different gestational ages（GA） in the tertiary hospitals in Northwest China. MethodsA total of 440 neonates diagnosed with RDS between January and December, 2011 in 12 tertiary hospitals in Northwest China were enrolled and classified into three groups： early preterm（GA〈34 weeks; n=247）, late preterm（GA 34-36^＋6 weeks; n=131） and full-term（GA≥37 weeks; n=62）. The clinical data, including perinatal factors, prevention and treatment, complications and prognosis, were comparatively analyzed among the three groups. Results The rate of multiple births in the early preterm group was higher than the other two groups. The two preterm groups showed a higher incidence of premature rupture of membranes than the full-term group. The full-term group had a higher rate of cesarean section without contractions than the two preterm groups. The early preterm group had the highest application rate of antenatal steroids. Compared with the other two groups, the early preterm group had a higher application rate of pulmonary surfactants（PS） and an earlier time of first application of PS. The full-term group had a lower resuscitation rate than the two preterm groups. The early preterm group showed a higher incidence of patent ductus arteriosus and intracranial hemorrhage than the other two groups. The cure rate of RDS（78.2%） was the highest in the full-term group, followed by the late preterm group（58.6%） and the early preterm group（42.9%）. Conclusions RDS infants of different GA in Northwest China have significant differences in perinatal factors, antenatal prevention, PS treatment, complications and prognosis.