足月儿和近足月儿呼吸窘迫综合征需重复应用肺表面活性物质高危因素分析  

Risk factors for repeat use of pulmonary surfactant in the treatment of respiratory distress syndrome in the term and near-term neonate

作　　者：余晶[1] 祝华平[1] 李宁[1] 陈曦[1] 夏世文[1] 

机构地区：[1]湖北省妇幼保健院新生儿科,武汉430070

出　　处：《中国新生儿科杂志》2016年第2期115-119,共5页Chinese Journal of Neonatology

摘　　要：目的探讨足月儿和近足月儿呼吸窘迫综合征（RDS）需重复应用肺表面活性物质（PS）治疗的高危因素。方法回顾性分析我院新生儿重症监护病房2012年1月至2014年12月应用牛肺表面活性物质治疗的足月和近足月RDS患儿临床资料,根据应用PS次数分为单次组和重复组,比较两组患儿一般情况、基础疾病、应用PS日龄和剂量等,并行多因素Logistic回归分析。结果共纳入130例,其中单次组85例,重复组45例,PS重复使用率34.6%。重复组出生窒息、母亲妊娠期高血压、治疗前胸部X线片RDSⅢ~Ⅳ级比例、首次PS日龄、呼吸支持时间明显高于单次组（P〈0.05）,治疗前动脉血氧分压/吸入氧浓度（PaO_2/FiO_2）、治愈率均低于单次组（P〈0.05）,重复组伴有败血症、肺出血、休克、动脉导管未闭的比例高于单次组（P〈0.05）。Logistic回归分析显示出生窒息（OR=5.674,95%CI 1.378~23.354）、首次PS日龄（OR=1.092,95%CI1.002~1.191）及合并动脉导管未闭（OR=23.499,95%CI 2.348~235.152）是足月儿和近足月儿RDS需重复使用PS治疗的独立危险因素。结论需重复使用PS治疗足月儿和近足月儿RDS的高危因素包括出生窒息、应用PS时间延迟及合并动脉导管未闭。Objective To identify risk factors associated with repeat use of pulmonary surfactant（ PS） in the treatment of respiratory distress syndrome（ RDS） in the term and near-term neonate.Methods There were 130 term and near-term newborns with RDS who were treated with pulmonary surfactant were enrolled. These infants were categorized into two groups： single-dose group（ 85 cases）and repeat-dose group（ 45 cases）. The differences in basic information were compared between the two groups,and logistic regression analysis was used to identify the risk factors for repeat use of pulmonary surfactant. Results The repeat utilization rate of PS was 34. 6%. The incidence of asphyxia,maternal gestational hypertension,X-ray RDS grade 3- 4,the age of first dose PS,respiratory support time in the repeat-dose group was significantly higher than in the single-dose group（ P〈0. 05）. PaO_2/ FiO_2 and the cure rate in the repeat-dose group were significantly lower than in single-dose group（ P〈0. 05）. The incidence of sepsis,pulmonary hemorrhage,shock and patent ductus arteriosus（ PDA） in the repeatdose group was significantly higher than in the single-dose group（ P〈0. 05）. Further logistic regression analysis showed that birth asphyxia（ OR = 5. 674,95% CI 1. 378- 23. 354,the age of first dose of PS（ OR = 1. 092,95% CI 1. 002- 1. 191） and PDA（ OR = 23. 499,95% CI 2. 348- 235. 152） were the independent risk factors for repeat use of pulmonary surfactant. Conclusions Birth asphyxia,the age of first dose PS and PDA are the risk factors for repeat use of pulmonary surfactant in the treatment of RDS in the term and near-term neonate.

关 键 词：肺表面活性物质 呼吸窘迫综合征 新生儿 危险因素 

分 类 号：R720.597[医药卫生—急诊医学]