晚期早产儿和足月儿呼吸窘迫综合征的临床特点  

Clinical characteristics and outcomes of respiratory distress syndrome in term and late-preterm neonates

作　　者：陈安[1] 施丽萍[1] 郑季彦[1] 杜立中[1] 

机构地区：[1]浙江大学医学院附属儿童医院新生儿重症监护病房,杭州310003

出　　处：《中华儿科杂志》2008年第9期654-657,共4页Chinese Journal of Pediatrics

摘　　要：目的比较晚期早产儿或足月儿和早产儿呼吸窘迫综合征（respiratory distress syndrome，RDS）的特点，探讨晚期早产儿或足月儿RDS的临床特征和发病机理。方法2005年5月至2007年5月，在本院住院177例RDS患儿，〈35周为早产组，103例，〉135周为晚期早产儿或足月儿组，74例。结果早产组开始应用呼吸机时间为8．7h，持续应用呼吸机时间4．3d，氧合指数（Oxygenation index，OI）11．9，Pa02／PA020．29，有28例应用表面活性物质（pulmonary surfactant，PS），其中11例应用呼吸机，应用PS前及后2h、8～12h、20—24h OI分别为10．5、5．4、3．4、4．3（P〈0．01）。晚期早产儿或足月儿组开始应用呼吸机时间为27．8h（与早产组比，下同，P〈0．01），持续应用呼吸机时间3．7d，OI 19．70（P〈0．01），PaO2／PAO20．16（P〈0．01），8例应用PS中有7例应用呼吸机，应用PS前及后2h、8—12h、20—24h01分别为11．2、7．6、7．5、7．6（其中8—12h、20—24h OI与早产组比，P均〈0．05）。结论晚期早产儿或足月儿RDS患儿以产程未发动的剖宫产为主，开始应用呼吸机时间较晚，氧合情况较差，表面活性物质应用效果较差，易发生气胸和PPHN。Objective Respiratory distress syndrome （RDS） is a frequently seen acute respiratory disorder in the newborn infants. Since the original description of deficiency of the pulmonary surfactant in premature neonates by Avery in 1959, RDS has most commonly been attributed to developmental immaturity of surfactant production. But in clinical practice it has been found that there was RDS in term and late-term neonates. Many of them were recognized as transient tachypnea at the beginning, they were diagnosed as RDS until respiratory distress and the typical radiological signs were demonstrated. The purpose of this study was to investigate the clinical characteristics of RDS of term and late-term neonates. Methods All neonates admitted to the neonatal intensive care unit of the Children＇s Hospital, Zhejiang University School of Medicine between May, 2005 and May, 2007 on the basis of RDS were analyzed. RDS was diagnosed when respiratory distress and the typical radiological signs were documented. Patients were grouped into preterm group （Group 1, gestational age 〈 35 w, n = 103） and term and late-term group （Group 2, gestational age ≥35 w, n = 74 ）. Results In Group 1, 76 preterm infants were male, the mean gestational age was 31.1 w, the mean Apgar score at 1 min was 7. 6, the mean birth weight was 1702 g, 56 cases were vaginally delivered and 47 were delivered through Cesarean section. Only one was delivered via elective Cesarean section before onset of labor. A total of 88 patients needed mechanical ventilation （ MV）, the time for beginning MV was 8. 7 h （1-72 h）, and lasted for 4. 3 d （0. 5-29 d）. The oxygenation index （OI） was 11.9 （10. 00-52. 63） and PaO2/PAO2 was 0. 29 （0. 03-0. 98）. Four patients had an OI 〉40. A total of 28 patients were treated with pulmonary surfactant （PS） , and 11 of the 28 underwent MV, the OI before and 2 h, 8-12 h and 20-24 h after using PS were 10. 5, 5.4, 3.4, and 4. 3, respectively （P 〈0.01 ）. A total of 33 patients in Group i had i

关 键 词：呼吸窘迫综合征 新生儿 婴儿 新生 婴儿 早产 呼吸 人工 

分 类 号：R686[医药卫生—骨科学]