基于“蒙特勒标准”的新生儿急性呼吸窘迫综合征的临床特征和危险因素分析

Analysis of clinical characteristics and risk factors of neonatal acute respiratory distress syndrome based on the“Montreux Standard”

目的分析基于“蒙特勒标准”的新生儿急性呼吸窘迫综合征(ARDS)的临床特征及危险因素。方法2019年1月至12月在扬州大学医学院附属淮安市妇幼保健院新生儿医学中心住院治疗的新生儿总人数为3930例,选择其中具有呼吸困难症状的964例新生儿为研究对象,参照蒙特勒标准分为ARDS组(204例)和非ARDS组(760例),分析ARDS的病因、临床特征及发生ARDS的危险因素。结果2019年本院有呼吸困难症状患儿占同期新生儿收治患儿的24.5%(964/3930),ARDS患儿占同期新生儿收治患儿的5.2%(204/3930),其中轻度ARDS为76例(37.3%),中度ARDS为69例(33.8%),重度ARDS为59例(28.9%)。ARDS组新生儿的胎龄和出生体重均低于非ARDS组,差异均有统计学意义(P<0.05)。ARDS组新生儿的窒息、孕母妊娠期并发症、感染、手术、Downes评分、氧合指数(OI)、机械通气、辅助通气时间、使用过肺泡表面活性物质(PS)、使用一氧化氮(NO)、并发症均高于非ARDS组,差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,感染、窒息、手术、PS缺乏和高Downes评分是发生ARDS的危险因素(P<0.05)。结论新生儿ARDS的主要病因是感染、窒息、手术、胎粪和奶汁吸入,感染、窒息、手术、PS缺乏和高Downes评分是发生ARDS的危险因素。

Objective To analyze the clinical features and risk factors of neonatal acute respiratory distress syndrome(ARDS)based on the“Montreux Standard”.Methods The total number of newborns hospitalized at Huai′an Maternal and Child Health Center affiliated to Yangzhou University Medical College from January to December 2019 was 3930,of which 964 newborns with dyspnea symptoms were selected as subjects.According to“Montreux standard”,they were divided into the ARDS group(204 cases)and the non ARDS group(760 cases).The etiology,clinical characteristics and risk factors of ARDS were analyzed.Results In 2019,children with dyspnea symptoms in our hospital accounted for 24.5%(964/3930)of the newborns admitted in the same period,and children with ARDS accounted for 5.2%(204/3930)of the newborns admitted in the same period,and which were 76 cases(37.3%)with mild ARDS,69 cases(33.8%)with moderate ARDS,and 59 cases(28.9%)with severe ARDS.The gestational age and birth weight of neonates in the ARDS group were lower than those in the non-ARDS group,and the differences were statistically significant(P<0.05).Neonatal asphyxia,pregnancy complications,infection,surgery,Downes score,oxygenation index(OI),mechanical ventilation,assisted ventilation time,use of alveolar surfactant(PS),use of nitric oxide(NO),complications in the ARDS group were all higher than those in the non-ARDS group,and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that infection,asphyxia,surgery,PS deficiency and high Downes score were risk factors for ARDS(P<0.05).Conclusion The main causes of neonatal ARDS are infection,asphyxia,surgery,meconium and milk inhalation.Infection,asphyxia,surgery,PS deficiency and high Downes score are risk factors for ARDS.