影响新生儿肺透明膜病发病及预后的多因素分析

Multiple risk factors analysis of episode and prognosis of neonatal hyaline membrane disease

目的 探讨新生儿肺透明膜病 (HMD)发病及预后的危险因素。方法 以住院的HMD患儿 10 1例和同期住院孕龄相当的非HMD随机病历 111例为回顾分析对象。结果 男性较女性更易患HMD ,胎盘早剥、剖宫产及胎儿宫内窘迫是HMD的易感因素 ;产前用糖皮质激素 (GC)对HMD有预防作用 ;胃液泡沫振荡试验阴性率 82 1% (5 5 /6 7) ,明显高于对照组 ;生后 6h内发生HMD者占 94 1% (其中 39例出生即发病 ) ,病死率为41 8% ,对照组为 0 ,χ2 =5 4 17,P <0 0 1;HMD死亡组Apgar评分明显低于治愈组 ,X线胸片Ⅳ级病死率38 7% (13/2 2 ) ,Ⅰ、Ⅱ、Ⅲ级病死率 2 5 0 % (10 /40 ) ,χ2 =7 0 7,P <0 0 1;出生即发病者病死率 5 6 7% (17/30 ) ,而有一定潜伏期发病者病死率仅 2 9 7% (11/37) ,χ2 =4 94,P <0 0 5 ;孕龄与病死率呈负相关 (r =- 0 970 ,P<0 0 5 ) ,HMD合并肺出血或脑室内出血 (IVH)的病死率明显高于非出血者。结论 应避免HMD发病的各种危险因素 ;产前使用GC可降低HMD的发生。积极治疗易致HMD死亡的因素 ,可降低其病死率。

Objective To search the risk factors of episode and prognosis of neonatal hyaline membrane disease.Methods One hundred and one cases of neonatal hyaline membrane disease (HMD) in our ward from July 1994 to August 2000 were analysed , with control of 111 cases having no HMD were retrospectively analys ed.Results HMD was more common in males than in females.The predisposing factors included placental abruption, cesarean section and fetal distress. Antepartum use of glucocorticoid could prevent episode of HMD. The negative rate of bubble shake test taken from the sample of gastric juice was 82 1% (55/67), which was significantly higher than the control. Of 101 HMD infants, 95(94 1%)presented symptoms within 6 hours after birth, among whom 39 cases presented onset of illness immediately after birth. Cure rate of the HMD group was 52 2%,while the control was 89 0%,χ 2=29 89,P< 0 01 Mortality of HMD was 41 8%,while the control was 0,χ 2=54 17,P<0 01. Apgar score was significantly lower in death group than the cure group of HMD. Of grade Ⅳ lesion in chest X-ray,Mortality was 38 7%(13/22),with only 25%(10/40) in Ⅰ、Ⅱ、Ⅲ grade of the lesion together,χ 2=7 07,P<0 01 56 7% of the patients who presented symptoms just after being born died, however,only 29 7% of the patients who presented episode during some incubation period was dead,χ 2=4 94,P<0 05 There was negative correlation(r = - 0 970,P<0 05)between gestational age and mortality. The death rate of neonates with HMD complicated with pulmonary hemorrhage or IVH was statistically higher than those without bleeding.Conclusions Suspicious risk factors of HMD should be avoided and glucocorticoid should be used before delivery in order to reduce the incidence of HMD. It can decrease mortalily to actively treat those complications of HMD which easily lead to death.