新生儿急性呼吸窘迫综合征的临床特征及预后相关性分析

Clinical Features of Neonatal Acute Respiratory Distress Syndrome and its Prognostic Correlation Analysis

目的探讨新生儿急性呼吸窘迫综合征(ARDS)的临床特征及预后相关性分析。方法回顾性分析2018年1月~2019年3月在陆军军医大学大坪医院住院,胎龄32~42周的新生儿ARDS病例63例,根据有无死亡/遗留神经系统后遗症,分为死亡/后遗症组(31例)及痊愈组(32例),总结分析其临床特征及预后相关因素。结果死亡13例,致死率为20.6%(13/63);存活的50例患儿中,18例遗留不同程度的神经系统后遗症,致残率为36.0%(18/50)。单因素分析发现,胎龄、低白蛋白血症、低球蛋白血症是影响新生儿ARDS预后的变量(P<0.05),多因素Logistic回归分析显示,低白蛋白血症是影响预后的独立危险因素。死亡/后遗症组中,重度ARDS、使用肺表面活性物质≥3次的患儿占比显著高于痊愈组(P<0.05);与痊愈组比较,死亡/后遗症组二氧化碳分压、吸入氧浓度及呼吸机平均气道压更高(P<0.05),氧分压及碱剩余更低(P<0.05)。此外,死亡/后遗症组更易并发高血糖、持续性肺动脉高压、肺出血、心力衰竭、肾功能损害及颅内出血(P<0.05)。结论新生儿ARDS的致死、致残率高。低白蛋白血症是影响ARDS预后的独立危险因素。在治疗过程中应关注血气分析、及时调整呼吸机参数,减少并发症的出现。

Objective To understand clinical features and prognostic correlation analysis of neonatal acute respiratory distress syndrome(ARDS).Methods Sixty-three cases of neonatal ARDS with gestational age between 32 weeks and 42 weeks hospitalized in Daping Hospital were enrolled from January 2018 to March 2019,who were divided into death/sequela group(31 cases)and healing group(32 cases)according to whether or not death/neurological sequela.And clinical features and prognostic factors were summarized and analyzed.Results Thirteen of 63 died,and the mortality was 20.6%(13/63),and 18 of 50 who survived had varying degrees of neurological sequela,and the disability rate was 36.0%(18/50).Univariate analysis showed that gestational age,hypoalbuminemia and hypoglobulinemia were the variables affecting prognosis of ARDS(P<0.05),multivariate Logistic regression analysis showed that hypoalbuminemia was an independent risk factor affecting prognosis.Severe ARDS and pulmonary surfactant≥3 times in death/sequela group were higher than that in healing group(P<0.05).Compared with healing group,partial pressure of carbon dioxide,fraction of inspired oxygen and mean airway pressure of ventilator were higher(P<0.05),partial pressure of oxygen and base excess were lower in death/sequela group(P<0.05).Moreover,Death/sequela group was more likely to be complicated with hyperglycemia,persistent pulmonary hypertension,pulmonary hemorrhage,heart failure,renal impairment and intracranial hemorrhage than healing group(P<0.05).ConclusionMortality and disability of neonatal ARDS were high.Hypoproteinemiais was an independent risk factor affecting the prognosis of ARDS.Blood gas analysis and ventilator parameters would be closely monitored during treatment to reduce complications.