西北10家医院5年间2次早产儿呼吸窘迫综合征诊治状况调查  

Surveys on management of neonatal respiratory distress syndrome in ten hospitals in Northwest China in 2016 and 2021

作　　者：陈晨[1,2] 肖谧[2] 王凡[3] 吴高强[4] 程光清 唐瑾[6] 陈善昌[7] 周立 乔艳梅[9] 杨宏 刘俐 Chen Chen;Xiao Mi;Wang Fan;Wu Gaoqiang;Cheng Guangqing;Tang Jin;Chen Shanchang;Zhou Li;Qiao Yanmei;Yang Hong;Liu Li(Department of Neonatology,Xi'an Children's Hospital,Xi'an 710003,China;Department of Neonatology,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Neonatology,Lanzhou University Second Hospital,Lanzhou 730030,China;Department of Neonatology,Maternity and Child Health Care Hospital of Urumqi,Urumqi 830001,China;Department of Neonatology,Central Hospital of Ankang City,Ankang 725000,China;Department of Neonatology,People's Hospital of Baoji City,Baoji 721000,China;Department of Neonatology,Zhangye People's Hospital Affiliated to Hexi University,Zhangye 734000,China;Department of Neonatology,Maternity and Child Health Care Hospital of Lanzhou,Lanzhou 730030,China;Department of Pediatrics,People's Hospital of Shenmu City,Yulin 719300,China;Department of Neonatology,521 Hospital of Norinco Group,Xi'an 710065,China)

机构地区：[1]西安市儿童医院新生儿科,西安710003 [2]西安交通大学医学院第一附属医院新生儿科,西安710061 [3]兰州大学第二附属医院新生儿科,兰州730030 [4]乌鲁木齐市妇幼保健院新生儿科,乌鲁木齐830001 [5]陕西省安康市中心医院新生儿科,安康725000 [6]陕西省宝鸡市人民医院新生儿科,宝鸡721000 [7]河西学院附属张掖人民医院新生儿科,张掖734000 [8]兰州市妇幼保健院新生儿科,兰州730030 [9]陕西省神木市医院儿科,榆林719300 [10]兵器工业521医院新生儿科,西安710065

出　　处：《中华围产医学杂志》2023年第5期375-383,共9页Chinese Journal of Perinatal Medicine

摘　　要：目的分析西北地区10家医院5年间早产儿呼吸窘迫综合征(respiratory distress syndrome,RDS)的诊治状况的变化。方法回顾性调查西北地区新生儿协作组中部分医院(陕西省6家、甘肃省3家、新疆维吾尔自治区1家)新生儿重症监护病房2016年1月1日至12月31日和2021年1月1日至12月31日收治的入院日龄≤3 d并诊断为RDS的早产儿。比较5年间患儿的基本情况、围产期情况、治疗情况、并发症及预后等方面的变化。采用t检验、秩和检验或χ^(2)检验分析各组数据。结果(1)2016年及2021年符合纳入标准的RDS早产儿分别为322例和349例,胎龄30~33周+6的早产儿仍是主要患病人群,男性居多[分别为64.3%(207/322)和57.3%(200/349)]。2021年母亲平均生育年龄明显高于2016年[(30.6±4.8)岁与(28.6±5.4)岁,t=24.02,P<0.001],高龄产妇多于2016年[19.2%(67/349)与12.4%(40/322),χ^(2)=4.18,P<0.05]。(2)2021年与2016年相比,辅助生殖技术受孕率[11.7%(41/349)与1.9%(6/322),χ^(2)=25.12]、正规产前检查率[58.5%(204/349)与30.4%(98/322),χ^(2)=53.33]、产前糖皮质激素使用率[62.2%(217/349)与28.6%(92/322),χ^(2)=82.58]、剖宫产率[73.6%(257/349)与51.6%(166/322),χ^(2)=35.06]、选择性剖宫产率[24.1%(84/349)与6.5%(21/322),χ^(2)=39.07]和瘢痕子宫妊娠率[7.4%(26/349)与3.4%(11/322),χ^(2)=5.23]均较高(P值均<0.05);胎儿窘迫[30.1%(105/349)与20.2%(65/322),χ^(2)=8.68]、妊娠期高血压疾病[24.6%(86/349)与13.0%(42/322),χ^(2)=14.59]、胎膜早破[16.0%(56/349)与10.2%(33/322),χ^(2)=4.89]、羊水胎粪污染[12.6%(44/349)与5.6%(18/322),χ^(2)=9.83]、胎盘早剥[10.3%(36/349)与5.3%(17/322),χ^(2)=5.84]、妊娠期糖尿病[10.3%(36/349)与1.6%(5/322),χ^(2)=22.41]、绒毛膜羊膜炎[4.6%(16/349)与0.9%(3/322),χ^(2)=8.12]、甲状腺功能异常[4.3%(15/349)与0.6%(2/322),χ^(2)=7.88]和心脏病[4.3%(15/349)与0.3%(1/322),χ^(2)=9.17]的比例均较高(P值均<0.05)。(3)治疗情况:2021年肺表面活性物质(pulmonary surObjective To analyze the status of neonatal respiratory distress syndrome(RDS)management in 10 hospitals in Northwest China over the past five years and to investigate the strategies for improving the prevention and treatment of RDS.Methods This retrospective study involved premature infants with RDS who were admitted to the neonatal intensive care units(NICU)of 10 hospitals(six in Shaanxi Province,three in Gansu Province,and one in Xinjiang Uygur Autonomous Region)of the Northwest China Neonatal Collaborative Group within 3 d after birth from January 1 to December 31,2016,and from January 1 to December 31,2021.Basic information,perinatal condition,treatment approaches,complications,and prognosis of the patients were compared.T-test,rank sum,and Chi-square tests were used for statistical analysis.Result(1)This study enrolled 322 premature infants with RDS in 2016 and 349 in 2021.Premature infants at the gestational age of 30 to 33 weeks were mainly affected,and the majority were male[64.3%(207/322)and 57.3%(200/349)].The average maternal age in 2021 was older than that in 2016[(30.6±4.8)years vs(28.6±5.4)years,t=24.02,P<0.001],and the proportion of women at advanced maternal age was also higher in 2021[19.2%(67/349)vs 12.4%(40/322),χ^(2)=4.18,P<0.05].(2)The proportions of pregnancies conceived with assisted reproductive technologies[11.7%(41/349)vs 1.9%(6/322),χ^(2)=25.12],underwent routine prenatal examinations[58.5%(204/349)vs 30.4%(98/322),χ^(2)=53.33],exposed to steroids[62.2%(217/349)vs 28.6%(92/322),χ^(2)=82.58]and delivered by cesarean section or elective cesarean section[73.6%(257/349)vs 51.6%(166/322),χ^(2)=35.06;24.1%(84/349)vs 6.5%(21/322),χ^(2)=39.07],as well as the ratio of cesarean scar pregnancy[7.4%(26/349)vs 3.4%(11/322),χ^(2)=5.23]were all higher in 2021 than those in 2016(all P<0.05).Moreover,the incidence of fetal distress[30.1%(105/349)vs 20.2%(65/322),χ^(2)=8.68],gestational hypertension[24.6%(86/349)vs 13.0%(42/322),χ^(2)=14.59],premature rupture of membranes[16.0%(56/349)vs 10.2

关 键 词：呼吸窘迫综合征 新生儿 肺表面活性物质相关蛋白质类 糖皮质激素类 抗菌药 婴儿 早产 

分 类 号：R722.6[医药卫生—儿科]