新生儿雷诺现象的临床分析  

Clinical analysis of neonatal Raynaud’s phenomenon

作　　者：康华[1] 赵璞 张勤[1] 王文华[1] KANG Hua;ZHAO Pu;ZHANG Qin;WANG Wenhua(Department of Neonatology,Shaanxi Provincial People's Hospital,Shaanxi Xi'an 710068,China)

机构地区：[1]陕西省人民医院新生儿科,陕西西安710068

出　　处：《中国妇幼健康研究》2021年第1期152-157,共6页Chinese Journal of Woman and Child Health Research

摘　　要：目的探讨新生儿雷诺现象的临床特点、诊疗及预后。方法选取2016年1月至2018年12月陕西省人民医院新生儿重症监护病房收治的雷诺现象患儿临床资料进行回顾性分析。结果纳入雷诺现象新生儿11例,男8例,女3例;早产儿9例,足月儿2例;胎龄为28+2~40+2周,平均胎龄32+3周;入院体重为990~4200g,平均1963g;发病时间为生后14min至144h,平均46.0h。新生儿主要表现为手、足第2~4指(趾)或肢体末端发花、发绀、苍白,多数为单侧,少数为双侧;随着病情进展出现发花、发绀与苍白交替出现,并伴有局部水肿。患儿均有动脉穿刺病史;呼吸困难4例;凝血功能不同程度异常6例;临床败血症4例(白细胞计数和降钙素原及C反应蛋白(CRP)明显升高4例,血培养阳性1例)。采用肝素钠乳膏及多磺酸粘多糖乳膏交替外涂并按摩局部、酚妥拉明或硫酸镁热敷,体位性治疗,多巴胺、罂粟碱改善血管循环治疗;对凝血异常患儿予以伊诺肝素,病情严重者应用血浆,感染指标高时予以抗生素等综合治疗方法。1例患儿发生手指末端干性坏死脱落,其余患儿治愈。结论新生儿雷诺现象发病较早,早期症状不典型,如能采取措施减少在血管侧枝循环不良部位穿刺、严密观察病情,尽早发现异常、早期治疗可避免后遗症的发生。Objective To explore clinical features,diagnosis,treatment and prognosis of neonatal Raynaud’s phenomenon.Methods The clinical data of neonates with Raynaud’s phenomenon in Neonatal Intensive Care Unit(NICU)of Shaanxi Provincial People’s Hospital from January 2016 to December 2018 were analyzed retrospectively.Results 11 neonates with Raynaud’s phenomenon were enrolled in the study,including 8 males and 3 females,9 premature infants and 2 term infants.The gestational age at birth of the neonates was 28+2~40+2 weeks,with an average gestational age of 32+3 weeks.The body weight at admission of the neonates was 990~4200 g,with an average body weight of 1963 g.Onset time of Raynaud’s phenomenon was at 14 minutes~144 hours after birth,with an average onset time of 46.0 hours.The main manifestations of the neonates included local piebaldism,cyanosis and pallor in unilateral(a few in bilateral)hand or foot 2~4 fingers(toes)or extremities.With the progression of the disease,local piebaldism,cyanosis and pallor appeared alternately,accompanied by local edema.All neonates had a history of arteriopuncture.There were 4 cases of dyspnea,6 cases of abnormal blood coagulation function and 4 cases of clinical septicemia including 4 cases of significantly elevated white blood cell count(WBC),procalcitonin(PCT)and C reactive protein(CRP)and 1 case of positive blood culture.The neonates received comprehensive treatment:heparin sodium milk paste and polysulfonic acid milk paste were smeared to the local skins alternately and the skins were massaged for a while,and then the neonates were given hot compress with phentolamine(regitine)and magnesium sulfatet on the local skins.Postual therapy,dopamine and papaverine were administered to improve systemic circulation.For those neonates with dysfunction of blood coagulation,heparin even plasm were administered.For those infants with elevated infective indexes,antibiotics were given.Except one infant developed dry gangrene and exfoliation of finger extremities,other infants cured.

关 键 词：新生儿 雷诺现象 手足发绀 血管痉挛 

分 类 号：R725.4[医药卫生—儿科]