足月新生儿急性呼吸窘迫综合征临床特征及预后

Clinical characteristics and prognosis of acute respiratory distress syndrome in full-term new-born infants

为探讨足月新生儿急性呼吸窘迫综合征 (ARDS)的临床特征 ,提高对该病的认识 ,以便及早采取有效的治疗 ,参照1994年美国和欧洲ARDS评审会议制订的ARDS诊断标准 ,对1999年1月～2002年3月NICU住院的有青紫、呼吸困难、需机械通气治疗的87例足月新生儿进行回顾性调查分析。结果显示符合足月新生儿ARDS诊断者共10例 ,发病率11.5% ,死亡率20.0 %。其临床特征为 :①急性起病 ,原发病后 (11.4±13.8)h出现症状 ;②进行性呼吸困难 ,严重低氧血症 ;③PaO2/FiO2<200mmHg;④急性期胸部X线表现双肺弥漫性浸润影或“白肺”;⑤需用呼吸机进行机械通气治疗>48h ;⑥不能用其他呼吸系统疾病或心脏疾病解释。表明足月新生儿ARDS临床上并不少见 ,严密临床观察及动态胸部X线检查、血气分析可明确诊断 ,及早机械通气治疗 。

To investigate the clinical characteristics of acute respiratory distress syndrome(ARDS)in full_term newborn infants and to improveour understanding so that early effective treatment could be given. Eighty_seven full_term newborn infants with the presentation of cyanosis,dyspnea and requirement of asˉsisted mechanical ventilation admitted to NICU of our hospital were analyzed retrospective from January1999to March2002.The results showed that10of them were coincided with the diagnostic criteria of ARDS stipˉulated by American_European Consensus Conference(the incidence was about11.5%and the mortality was20.0%).The clinical features were as following:(1)Acute onset,all the symptoms appeared with mean time11.4±13.8h after primary diseases.(2)Progressive dyspnea,and severe hypoxemia.(3)PaO 2 /FiO 2 <200mmHg.(4)Diffuse infiltration or“white lung”in both lungs could be found in the chest X_ray film in acute period.(5)Requiring assisted mechanical ventilation for over48hours.(6)All these abnormalites could not be interpreted with other respiratory diseases and heart diseases,suggesting that the morbidity of ARDS in full_term newborn infants is not rare in clinic,so great attention should be paid to keep close observation in clinic and dynamic changes of the chest X_ray film as well as blood gas analysis to confirm the diagnosis,in this way,the mechanical ventilation treatment could be used as early as possible to improve the prognosis.