中晚期早产儿和足月儿呼吸窘迫综合征发生气胸的相关因素分析

Analysis of Related Factors of Pneumothorax in Moderate-to-late Preterm Infants and Full-term Infants with Respiratory Distress Syndrome

目的 分析中晚期早产儿及足月新生儿呼吸窘迫综合征(respiratory distress syndrome,RDS)的临床特征及合并气胸的影响因素。方法 回顾性分析2019年4月至2021年10月在山东大学齐鲁医院新生儿重症监护病房住院,胎龄≥32周的RDS病例125例,根据是否发生气胸分为气胸组(22例)和非气胸组(103例),比较两组患儿的临床特征及转归,分析、探讨中晚期早产儿及足月新生儿RDS发生气胸的相关因素。结果 大于等于32周的125例RDS患儿中,22例(17.60%)发生气胸。与无气胸组RDS患儿相比,发生气胸组RDS患儿的出生胎龄及出生体质量更大(P<0.05);两组患儿比较,在性别、出生方式、羊水情况、出生后1 min及5 min Apgar评分以及出生时接受复苏囊正压通气情况方面差异无统计学意(P>0.05)。发生气胸组RDS患儿与无气胸组相比,生后24 h的CRP、PCT更高(P<0.05),气胸组患儿接受有创机械通气的比率更高(P<0.05),两组差异有统计学意义(P<0.05);但发生气胸的RDS患儿与无气胸组相比,在住院时间方面无统计学差异。发生气胸组RDS患儿治愈出院21例,死亡1例(4.55%);无气胸组RDS患儿全部治愈出院。结论 中晚期早产儿及足月新生儿RDS合并气胸的风险高,尤其是出生胎龄和出生体质量大以及生后早期感染指标升高的RDS新生儿,在临床工作中,需进一步提高对RDS新生儿发生气胸的认识,以有效控制患儿病情进展,提高对该类患儿的救治水平。

Objective To analyze the clinical features of respiratory distress syndrome(RDS) in moderate-to-late preterm infants and fullterm infants and the risk factors of complicated with pneumothorax. Methods A retrospective analysis was conducted on clinical data of 125RDS infants with gestational age≥32 weeks, who were admitted to the neonatal intensive care unit of the hospital from April 2019 to October 2021. The patients were divided into pneumothorax group(22 cases) and non-pneumothorax group(103 cases) according to the occurrence of pneumothorax or not. To compare the clinical features and prognostic factors and to explore the related factors of pneumothorax in moderateto-late premature and full-term infants with RDS. Results Among the 125 children with RDS over 32 weeks, 22(17.60%) developed pneumothorax. Gestational age and birth weight were significantly higher in the group with pneumothorax than non-pneumothorax group(P<0.05), while there was no significant difference between the two groups in sex, delivery method, amniotic fluid status, Apgar score at 1min and 5 min, and positive pressure ventilation at birth(P>0.05). The values of CRP and PCT were higher and the rate of invasive ventilation was higher in RDS with pneumothorax than non-pneumothorax group(P<0.05), there was no significant difference in duration of hospitalization.21 cases of RDS in the group with pneumothorax were cured and discharged, 1 case died(4.55%), and all cases of RDS in the group without pneumothorax were cured and discharged. Conclusion The risk of pneumothorax in moderate-to-late premature and full-term infants with RDS is high, especially in those infants with RDS whose gestational age and birth weight are high, and whose infection index is high in the early stage of life, it is necessary to improve awareness of this disease so that disease exacerbation could be controlled and management could be improved.