新生儿胎粪吸入综合征并发肺出血的临床特征及预后分析

Clinical features and prognosis of meconium aspiration syndrome complicated by pulmonary hemorrhage in neonates

目的 探讨胎粪吸入综合征(MAS)并发新生儿肺出血(NPH)的临床特点及转归.方法 回顾性分析2015年12月至2018年12月收治的45例MAS并发NPH患儿(观察组)的临床资料,并选取同期住院未并发NPH的MAS患儿90例作为对照组,比较两组临床特征及转归.结果 观察组生后1 min Apgar评分显著低于对照组(P<0.05),而新生儿持续肺动脉高压、气漏综合征及休克的发生率、肺表面活性物质使用率显著高于对照组(P<0.05),C反应蛋白和氧合指数(OI)显著高于对照组(P<0.01).OI值早期诊断NPH的ROC曲线下面积0.959(95%CI:0.929~0.988,P<0.001),临界值为10.05,敏感性为80.0%,特异性为96.7%.在治愈出院的患儿中,观察组的呼吸机时间、吸氧时间及住院时间均较对照组明显延长(P<0.05).结论 MAS并发NPH患儿的机械通气时间更长,气漏综合征和休克的发生率更高;OI值或可作为MAS并发NPH的早期诊断指标.

Objective To study the clinical features and prognosis of meconium aspiration syndrome(MAS) complicated by neonatal pulmonary hemorrhage(NPH) in neonates. Methods A retrospective analysis was performed for the clinical data of 45 neonates with MAS complicated by NPH who were admitted to the hospital from December 2015 to December 2018(observation group). Ninety neonates with MAS who were hospitalized during the same period of time and had no pulmonary hemorrhage were enrolled as the control group. The two groups were compared in terms of clinical features and prognosis. Results The observation group had a significantly lower 1-minute Apgar score after birth than the control group(P<0.05). Compared with the control group, the observation group had significantly higher incidence rates of persistent pulmonary hypertension of the newborn, air leak syndrome and shock and a higher rate of use of pulmonary surfactant(P<0.05), as well as higher levels of C-reactive protein and oxygen index(OI)(P<0.01). In the early diagnosis of NPH, OI had a sensitivity of 80.0%, a specificity of 96.7%, and an area under the receiver operating characteristic curve of 0.959(95% confidence interval: 0.929-0.988, P<0.001) at the cut-off value of 10.05. For the children who were cured and discharged, the observation group had significantly longer duration of ventilation, duration of oxygen inhalation and length of hospital stay than the control group(P<0.05). Conclusions Neonates with MAS complicated by NPH tend to have a longer duration of ventilation and higher incidence rates of air leak syndrome and shock. OI may be used as an index for the early diagnosis of MAS complicated by NPH.