新生儿呼吸窘迫综合征论文：不同胎龄与不同分级新生儿呼吸窘迫综合征的临床分析

1、新生儿呼吸窘迫综合征论文:不同胎龄与不同分级新生儿呼吸窘迫综合征的临床分析【中文摘要】背景和随着围生医学迅速发展，新生儿存活率明显 提高,但越来越多的临床研究发现早产儿比例和新生儿呼吸窘迫综合 征（RDS, respiratory distress syndrome）发生率在逐年增加，尤其 以（近）足月儿RDS增多明显，不少研究己提出这与剖宫产增多有密切 关系。早产儿发生RDS主要与肺发育不成熟所致肺表面活性物质 （pulmonary surfactant, PS）缺乏有关，而（近）足月儿往往胎龄较大, 肺发育接近成熟，发生RDS与多种因素导致的PS继发性减少有关。由 于发病高危因素不同，临床

2、表现和治疗方案也不相同，但目前系统的 研究报道尚少。此外不同的高危因素所致早产儿RDS病情轻重不一， 其关联性仍不清楚。本研究根据不同胎龄和不同分级对纳入病例分组 比较从而达到以下研究1）探讨早期、晚期早产儿与足月儿RDS在发 病趋势和临床特征方而的差异,为临床合理诊治提供依据；2）通过比 较不同分级RDS早产儿的围生期状况，探讨不同高危因素与RDS严重 程度的相关性，为评估疗效和预后提供帮助。材料与方法1研究对象 与分组筛选我院新生儿病房在2006. 012010. 12期间住院的RDS患 儿963例，按胎龄不同分为三组：早期早产儿组，胎龄34周，共679 例；晚期早产儿组，胎龄34周37周

3、，共204例；足月儿组，胎龄2 37周，共80例。筛选其中在生后24h内拍得首张胸片的667例RDS 早产儿，按胸部正位X线片情况分为四组：RDS 1级,217例；RDS 2 级,225例；RDS 3级，126例；RDS 4级,99例。2方法对963例不同 胎龄RDS患儿进行以下5方而分析：（1）发病情况：RDS患儿占NICU 住院人数比例，每年不同胎龄组RDS患儿的构成比；（2）入院情况：包 括性别、Apgar评分、产前糖皮质激素使用；（3）高危因素：择期剖 宫产、宫内窘迫、出生窒息、胎膜早破、胎盘异常、母亲妊娠期疾病; 治疗情况：临床诊断时间，使用PS时间和次数，使用CPAP和机械 通气的

4、情况；（5）预后与并发症：包括治疗结局、肺部感染、败血症、 气胸、肺出血、支气管肺发育不良等。对667例不同分级RDS早产患 儿进行以下3方面分析：（1）产前情况：母亲年龄、受孕方式、妊娠 高血压疾病、胎膜早破、胎盘早剥、产前应用糖皮质激素情况、分娩 方式；一般情况：胎龄、出生体重、性别、是否双胎或双胎小宝、 围生期窒息等；（3）预后分析：使用PS情况、治疗结局、并发感染等。 3统计学方法应用SPSS17. 0软件进行统计分析,定量资料用均数土标 准差（xs）表示，多组之间比较采用单因素方差分析,组间差异采用 LSD-t检验两两比较，定性资料以率（%）表示，样木构成比或率的比较 采用卡方检验。

5、以护0.05为检验水准。结果1不同胎龄分组比较早 产儿是RDS的主要发病人群，近五年来RDS患儿数量占同期住院患儿 总数的比例呈增加趋势，依次为3. 7%, 7. 0%, 9. 2%, 12. 0%, 14. 3%,晚期 早产儿和足月儿RDS比例有增多趋势，卡方检验差异有统计学意义。 男婴发病率超过女婴，且胎龄和体重越大，男婴比例越高。早产儿发生 RDS的高危因素主要有胎膜早破、胎盘异常、母亲妊娠高血压疾病等, 足月儿发生RDS的高危因素主要是择期剖宫产与感染,差异有统计学 意义。晚期早产儿与足月儿临床诊断和应用PS时间均晚于早期早产 儿,在应用PS次数方而差异无统计学差异。足月儿RDS应用机

6、械通气 比例明显高于早产儿，其临床治愈率高，但容易并发气胸。早期早产儿 RDS并发肺出血比例和病重放弃率最高，而各组在其它并发症和死亡 率方而差异无统计学意义。2不同胸片分级分组比较不同胸片等级的 RDS早产儿在母亲年龄、产前糖皮质激素应用、分娩方式、胎膜早破、 胎盘早剥、男婴、双胎等方而的差异无统计学意义，但RDS分级越重, 胎龄和出生体重越小,Apgar评分W7分和母亲合并妊娠高血压疾病 的患儿比例越高，差异有统计学意义。随着RDS分级的加重，治愈率下 降,死亡和并发感染率增加。在治愈患儿中，分级越重，使用PS比例越 高，但住院时间越长,差异均有统计学意义。结论1新生儿呼吸窘迫综 合征(R

7、DS)多发生于早产儿，占住院患儿比例逐年增高,晚期早产儿和 足月儿RDS比例有增多趋势；2早期、晚期早产儿与足月儿RDS在高 危因素、起病特点、治疗效果、预后及并发症等方而存在差异，诊治 需考虑胎龄因素；3足月儿RDS多与择期剖宫产、感染有关,发病相 对较晚，对PS治疗效果欠佳，应用机械通气比例高，容易合并发气胸， 应引起足够重视；4RDS的分级主要与早产程度、岀生体重、围生期 窒息等高危因素相关，分级越重，治疗效果和预后越差。【英文摘要】Background and purposeWith the rapid development of perinatal medicine, the ne

8、onatal survival rate has been significantly improved However, more and more clinical studies have demonstrated that the prevalence of premature infants and neonatal respiratory distress syndrome (RDS) was also increasing year by year. The ratio of RDS was especially high in term or near term infants

9、， which has been reported to be closely connected with cesarean section Lacking sufficient pulmonary surfactant (PS) because of immature lung is the main reason for RDS in preterm infants, whereas deficiency of PS caused by various factors is intimately related to the RDS in term or near term infant

10、s, whose lung is almost mature Despite of different risk factors, clinical manifestations and treatment between preterm infants RDS and term/near term infants RDS, systemic comparison was rarely reported Moreover, since different risk factors will lead to different clinic presentation in preterm inf

11、ants RDS, it is necessary to elucidate the relationship between them .This study was designed to compare cases according to different gestational ages and different grades so as to achieve these objectives:1) To provide a new basis for clinical theraphy through investigate the different clinical cha

12、racteristics and incidence of early preterm infants, late preterm infants and full term infants with RDS; 2) To understand the relevance between different risk factors and serious degree of RDS by comparing the perinatal conditions of different classifications of preterm RDS infants to provides the

13、basis for assessing the curative effect and prognosis .Materials and methods1 Objects and groupingA total of 963 RDS infants were recruited from the neonatal intensive care unit of the Third Affiliated Hospital of Zhengzhou University between January, 2006 and December, 2010. Cases were divided into

14、 three groups:early preterm infants group (gestational age34 weeks,679 cases), late preterm infants group (gestational age 34-37 weeks, 204 cases), and full-term infants group (gestational age$=37 weeks, 80 cases) Among these cases,667 subjects had chest xray radiograph within 24 hours after birth,

15、and the degree of RDS were classified into 4 groups according to the chest X-ray:RDS grade 1 (217cases), RDS grade 2 (225cases), RDS grade 3 (126cases), RDS grade 4 (99 cases).2 MethodsAll of the 963 RDS cases with different gestational ages were analyzed by the following aspects：(l) incidence:the p

16、ercentage of RDS cases in all NICU patients, the constituent ratio of RDS infants with different gestational age in each year;(2)general situation:including gender, Apgar score, and the condition of using corticosteroids before delivery; (3) risk factors:elective cesarean section, intrauterine distr

17、ess, birth asphyxia, premature rupture of membranes, abnormal of placenta, diseases of mother in pregnancy; (4) treatment:the time window of diagnosing RDS, duration and frequency of using pulmonary surfactant, situation of using CPAP and mechanical ventilation; (5) prognosis and complications:inclu

18、ding treatment outcome and pulmonary infection, sepsis, pneumothorax, pulmonary edema, and bronchial lung dysplasia 667 preterm with different RDS grades were analyzed by the following three aspects：(l) the Prenatal situation:mother s age, conception type, pregnancy-induced hypertension syndrome, pr

19、emature rupture of membranes, abrupt io placentae, condition of using corticosteroids before delivery, delivery mode; (2) the general situation:gestational age, birth weight, sex, whether twins or the small one, perinatai asphyxia; (3) the prognosis analysis:use PS, therapeutic outcome, coincide inf

20、ection, etc 3 Statisties analysisAll statistical data were analyzed by SPSS 17. 0 software, quantitative data were presented as mean standard deviation (xs) One-way analysis of variance was used to compare the means during groups and LSD-t test was used between groups Qualitative data were presented

21、 as rate (%) and compared with Chi-square test P 0. 05 was considered as statistically significant. Resultsl Comparisons among groups of different gestational ageRDS mainly occurred in the preterm infants.There was an increasing tendency regarding the proportion of RDS infants in all hospital patien

22、ts during the recent five years, and the percentage was 3. 7%, 7. 0%, 9. 2%, 12. 0%, and 14. 3% respectively. The prevalence of RDS in late preterm infants and term infants was increasing with statistically significant The proportion of RDS in male was higher than that in females, especially when th

23、e gestational ages and weight are greater The risk factors of preterm RDS were closely releva nt to the rupture of membranes, placental abnormality, women with pregnancy-induced hypertension and so on, while the full-term newborns with RDS were mainly related to selective cesarean section. The diagn

24、osis of the full-term RDS was later than that of the preterm RDS. The treatment with mechanical ventilation and the clinical cure rate in full-term RDS infants was significantly higher than that in the preterm infants, but with more pneumothorax occured. Early preterm infants with RDS had a higher p

25、roportion of pulmonary hemorrhage and abandonment rate. No significant differences were found in other complications and mortality between groups 2 Comparisons among groups of different gradesThere were no significant differences in the maternal age, the percentage of using antenatal corticosteroids

26、, premature rupture of membranes, placental abruption, the delivery mode, male, and twins among preterm RDS infants with different chest X-ray radiograph grades However, the higher the grades were, the smaller the gestational age and the birth weight was The percentage of the infants with Apgar scor

27、e less than 7 and maternal pregnancy-induced hypertension increased as the severity of grade increased In addition, the cure rate decreased with more death and infection, the percentage of using PS increased, and the hospitalization time increased when the grades increased Conclusionsl Neonatal RDS

28、predominantly occurred in the preterm infants and the proportion of RDS in hospital patients was increasing year by year There was an increasing tendency of prevalence of RDS in late preterm infants and term infants 2 Due to the fact that the risk factors, the clinical presentations, the treatment and the complications are different among the early preterm RDS, late preterm RDS infants and term RDS, gestational ages should be considered when making di