晚期早产儿呼吸窘迫综合征的临床研究

Clinical research of respiratory distress syndrome in late preterm infants

目的探讨晚期早产儿呼吸窘迫综合征(RDS)的发生率、高危因素和临床特征。方法回顾性分析2010年1月~2013年12月于扬州大学医学院附属淮安市妇幼保健院新生儿医学中心重症监护病房住院治疗、入院时日龄<72 h、出生胎龄在34+1~36+6周、治愈出院的早产儿临床资料。结果共纳入452例,RDS组152例,晚期早产儿的RDS发生率为33.6%(152/452);对照组300例。两组患儿出生体重、胎龄、胎次等比较,差异均无统计学意义(P>0.05)。两组患儿其余基本情况比较,差异有统计学意义(P<0.05)。RDS组患儿胎膜早破发生率低于对照组(P<0.05),胎盘异常、胎儿宫内窘迫、CPAP、气管插管、肺出血、持续肺动脉高压、气漏、呼吸机相关性肺炎、颅内出血的发生率均高于对照组(P<0.05)。Logistic回归分析发现,剖宫产、胎膜早破、瘢痕子宫和社会因素导致的选择性剖宫产是晚期早产儿RDS发病的高危因素(P<0.05)。结论晚期早产儿的RDS发生率较高、其病情较重和并发症较多。胎膜早破、剖宫产、瘢痕子宫和社会因素导致的选择性剖宫产是晚期早产儿RDS发病的高危因素。

Objective To investigate the incidence, risk factors, clinical features of respiratory distress syndrome（RDS）in the late preterm infants. Methods The clinical data of prematures who were hospitalized and cured in Maternal and Child Healthcare Hospital of Huaian Affiliated to Yangzhou University Medical Academy from January 2010 to December 2013 were retrospectively analyzed. All the prematures who ′s age were less than 72 hours and the gestational age were 34＋1-36＋6weeks. Results Participants included 452 cases, RDS group was 152 cases and control group was 300 cases. The incidence rate of RDS in late preterm infants was 33.6%（152/452）. There were no statistical significance of two groups in birth weight, gestational age, fetal time（P〈0.05）. The rest of basic situation of two groups was compared, with statistical difference（P〈0.05）.Incidence rate of premature rupture of membranes in RDS group was lower than that in control group（P〈0.05）. Incidence rate of placental abnormality, fetal distress, CPAP, tracheal intubation,pulmonary hemorrhage, PPHN, gas leak, VAP and intracranial hemorrhage in RDS group were higher than those in control group（P〈0.05）. Logistic regression analysis showed that the risk factors of RDS in the late preterm infants were premature rupture of memberane, cesarean elicery, elective caesarean section leaded by scar uterus and social factors（P〈0.05）. Conclusion Late preterm infants with a higher incidence of RDS, heavier and more complications. The risk factors of RDS in the late preterm infants are premature rupture of memberane, cesarean elicery, elective caesarean section leaded by scar uterus and social factors.