内蒙古地区新生儿急性呼吸窘迫综合征多中心回顾性临床流行病学调查及危险因素分析  

Clinical epidemiological investigation and risk factor analysis of neonatal acute respiratory distress syndrome in Inner Mongolia:a multi-center retrospective study

作　　者：赵嘉琪 梅花[1] 王晓丽 何海英[2] 白晓婷 谢华 佟丽 张晓梅 李婷 Zhao Jiaqi;Mei Hua;Wang Xiaoli;He Haiying;Bai Xiaoting;Xie Hua;Tong Li;Zhang Xiaomei;Li Ting(Department of Neonatology,Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010050,China;Department of Neonatology,the Third Staff Hospital of Baotou Steel Group,Baotou 014010,China;Department of Neonatology,the Affiliated Hospital of Chifeng University,Chifeng 024050,China;Department of Neonatology,Inner Mongolia Autonomous Region People's Hospital,Hohhot 010017,China;Department of Neonatology,Ordos Central Hospital,Ordos 017000,China)

机构地区：[1]内蒙古医科大学附属医院新生儿科,呼和浩特010050 [2]包钢集团第三职工医院新生儿科,包头014010 [3]赤峰学院附属医院新生儿科,赤峰024050 [4]内蒙古自治区人民医院新生儿科,呼和浩特010017 [5]鄂尔多斯市中心医院新生儿科,鄂尔多斯017000

出　　处：《中华围产医学杂志》2024年第4期285-293,共9页Chinese Journal of Perinatal Medicine

基　　金：内蒙古自然科学基金(2020MS08034);自治区卫生健康委医疗卫生科技计划项目(202201291);内蒙古自治区重点研发和成果转化计划项目(2022YFSH0088)。

摘　　要：目的探讨内蒙古部分地区新生儿急性呼吸窘迫综合征(neonatal acute respiratory distress syndrome,NARDS)的流行病学特点,以及NARDS严重程度的高危因素。方法2017年9月至2021年12月内蒙古地区5家三级甲等综合医院新生儿重症监护病房(neonatal intensive care unit,NICU)共收治355例符合"蒙特勒标准"的NARDS患儿,排除资料不全者36例,余319例纳入回顾性分析。根据氧指数将患儿分为轻度组(n=133)、中度组(n=133)及重度组(n=53),采用Kruskal-WallisH检验和χ^(2)检验比较3组基本情况、起病时间、实验室检查结果、治疗及并发症发生情况等,采用多因素logistic回归分析影响NARDS严重程度的高危因素。结果研究期间NARDS患儿占NICU患儿的1.6%(355/22071),病死率为12.5%(40/319)。319例NARDS患儿中,45.5%(145/319)同时存在2种及以上原发疾病,原发疾病主要为败血症(153例,48.0%)、窒息(123例,38.6%)、肺炎(90例,28.2%)、肺出血(50例,15.7%)、胎粪吸入综合征(39例,12.2%)及新生儿坏死性小肠结肠炎(9例,2.8%)。主要的合并症包括低白蛋白血症(110例,34.5%)、黄疸(95例,29.8%)、新生儿持续性肺动脉高压(69例,21.6%)等。多因素logistic回归分析发现,生后5 min Apgar评分≤7分(OR=4.416,95%CI:1.591~12.258)、孕母分娩前7天发生感染性疾病(OR=22.362,95%CI:4.941~101.202)、病原学检查阳性(OR=20.616,95%CI:4.049~104.955)、使用有创通气(OR=59.807,95%CI:9.821~364.230)、常频机械通气失败后转为高频振荡通气(OR=3.640,95%CI:1.178~11.242)、使用2剂及2剂以上外源性肺表面活性物质(OR=3.136,95%CI:1.265~7.774)和合并肺出血(OR=11.804,95%CI:1.045~133.304)是增加NARDS严重程度的危险因素;而辅助通气时长(OR=0.994,95%CI:0.906~0.985)是保护因素(P值均<0.05)。结论内蒙古部分地区NARDS病死率较高,原发疾病主要为败血症、窒息和肺炎等。临床需重视NARDS的高危因素,以期降低NARDS患儿的严重程度。Objective To investigate the epidemiological characteristics of neonatal acute respiratory distress syndrome(NARDS)in parts of Inner Mongolia and the risk factors affecting the severity of NARDS.Methods Totally,355 neonates with NARDS,meeting the Montreux criteria,who were admitted to the neonatal intensive care unit(NICU)of five tertiary general hospitals in Inner Mongolia from September 2017 to December 2021,36 cases with incomplete data were excluded,and 319 cases were enrolled in this retrospective epidemiological survey.The infants were categorized into mild(n=133),moderate(n=133),and severe(n=53)groups based on the oxygen index.Kruskal-Wallis H test and Chi-square test were employed to compare basic characteristics,onset time,laboratory examination results,treatment,and complications among the three groups.A multivariate logistic regression model was used to analyze independent high-risk factors influencing the severity of NARDS.Results During the study period,NARDS accounted for 1.6%(355/22071)of neonates in the NICU,with a mortality rate of 12.5%(40/319).Of 319 cases of NARDS,45.5%(145/319)had two or more primary diseases,the primary diseases were sepsis(153 cases,48.0%),asphyxia(123 cases,38.6%),pneumonia(90 cases,28.2%),pulmonary hemorrhage(50 cases,15.7%),meconium aspiration syndrome(39 cases,12.2%)and neonatal necrotizing enterocolitis(nine cases,2.8%).Major complications included hypoalbuminemia(110 cases,34.5%),jaundice(95 cases,29.8%),and persistent pulmonary hypertension of the newborn(69 cases,21.6%).Multivariate logistic regression analysis revealed that maternal Apgar score≤7 at 5 min(OR=4.416,95%CI:1.591-12.258),maternal infectious disease within 7 days before delivery(OR=22.362,95%CI:4.941-101.202),positive pathogen examination(OR=20.616,95%CI:4.049-104.955),using invasive ventilation(OR=59.807,95%CI:9.821-364.230),conversion to high frequency oscillatory ventilation after the failure of normal frequency ventilation(OR=3.640,95%CI:1.178-11.242),using two or more doses of exogenous pulmonary

关 键 词：呼吸窘迫综合征 新生儿 急性病 回顾性研究 流行病学研究 

分 类 号：R722.1[医药卫生—儿科] R181.3[医药卫生—临床医学]