新生儿呼吸窘迫综合征研究进展

Research Progress of Neonatal Respiratory Distress Syndrome

新生儿呼吸窘迫综合征(Neonatal Respiratory Distress Syndrome, NRDS)是由于肺表面活性物质缺乏所致的一种广泛肺泡萎陷损伤渗出的急性呼吸衰竭。肺表面活性物质能降低肺泡表面张力,改善肺顺应性,防止肺泡萎陷。NRDS多见于早产儿,但近年来随着剖宫产率上升,晚期早产儿及足月儿发生NRDS的比例也显著升高。该病常表现为生后不久出现进行性呼吸困难、呻吟、吐沫等,胸片提示两肺透亮度减低甚至出现白肺,通过合适的氧疗及PS替代治疗及后可改善。由于产前预防性糖皮质激素的使用和及时的治疗,NRDS的病死率及并发症发生率逐渐下降。本文将从NRDS的病理生理和发病机制、流行病学、发病相关因素、辅助检查及防治这五个方面进行综述。

Neonatal Respiratory Distress Syndrome (NRDS) is a type of acute respiratory failure caused by extensive alveolar collapse injury and exudation in both lungs due to lack of pulmonary surfactant. Pulmonary surfactant can reduce alveolar surface tension, improve lung compliance and prevent alveolar collapse. NRDS are more common in premature infants, but with the increase of cesarean section rate in recent years, the proportion of NRDS in late preterm and term infants also increased significantly. The disease often presents with progressive dyspnea, moaning, spitting, etc., shortly after birth. Chest radiographs suggest that the opacity of both lungs is reduced and even white lungs appear, which can be improved by appropriate oxygen therapy and PS replacement therapy. Due to the use of prenatal prophylactic glucocorticoids and timely treatment, the mortality and complication rate of NRDS have gradually decreased. This article will review the pathophysiology and pathogenesis of NRDS, epidemiology, pathogenesis related factors, auxiliary examination and prevention of NRDS.