摘要
目的探讨超低出生体重(extremely low birth weight,ELBW)婴儿对复苏、呼吸支持的需求及其呼吸系统并发症发生情况。方法选择2017年1~12月北京市16家医疗机构收治的ELBW婴儿进行回顾性分析,根据婴儿是否医嘱出院及胎龄是否<28周进行分组,总结ELBW婴儿救治、呼吸支持及呼吸系统并发症发生情况。结果研究期间共收治ELBW婴儿137例,母亲产前应用糖皮质激素97例(70.8%),患儿生后在产房/手术室进行气管插管98例(71.5%),诊断新生儿呼吸窘迫综合征110例(80.3%),其中107例(97.3%)接受至少一次肺表面活性物质治疗。医嘱出院组92例(67.2%),非医嘱出院组45例(32.8%)。与医嘱出院组相比,住院<14 d非医嘱出院组患儿胎龄更小、胎龄<28周比例更高,差异有统计学意义(P<0.01);住院<14 d非医嘱出院组患儿生后接受胸外按压、肾上腺素复苏的比例高于医嘱出院组,差异有统计学意义(P<0.05)。医嘱出院组患儿中,支气管肺发育不良发生率54.3%(50/92);胎龄<28周组ELBW婴儿较胎龄≥28周组无创通气时间更长[(37.8±19.6)d比(24.2±13.0)d],支气管肺发育不良发生率更高(75.6%比30.3%),住院时间更长[85.0(71.0,102.5)d比64.0(53.0,76.0)d],家庭氧疗比例更高(22.4%比7.0%),差异均有统计学意义(P<0.05);不同胎龄组机械通气时间相似[10.0(1.3,29.0)d比4.7(2.2,10.3)d,P>0.05]。结论大部分ELBW婴儿出生后需要气管插管复苏,且胎龄越小,需要呼吸支持时间越久,呼吸系统远期并发症发生率越高。
Objective To study the current status of delivery room/operating room(DR/OR)resuscitation,early respiratory supports and respiratory tract complications in extremely low birth weight(ELBW)infants.Method Between January 2017 and December 2017,ELBW infants born in sixteen medical institutions in Beijing were retrospectively studied.The infants were assigned into groups according to whether they were discharged following medical advice(follow-advice group and not-follow-advice group)and whether their gestational age(GA)was less than 28 weeks(<28 w group and≥28 w group).The treatment,respiratory support and respiratory tract complications of ELBW infants were summarized.Result A total of 137 ELBW infants were admitted to 16 NICUs.Of all ELBW infants,98 cases(71.5%)were intubated in DR/OR,mothers of 97 infants(70.8%)received antenatal steroid(ANS)therapy.80.3%of the infants(110/137)were diagnosed with respiratory distress syndrome(RDS)and 107 cases(97.3%,107/110)received at least one dose of pulmonary surfactant(PS)replacement therapy.92 cases(67.2%,92/137)were discharged following doctor's advice.Compared with the follow-advice group,the not-follow-advice group who were hospitalized for less than 14 days had smaller GA and higher proportion of GA<28 w(P<0.01).The not-follow-advice group who were hospitalized for less than 14 days had higher incidences receiving chest compressions and epinephrine than the follow-advice group(P<0.05).The incidence of bronchopulmonary dysplasia(BPD)was 54.3%(50/92)in follow-advice group.Compared with≥28 w group,infants in<28 w group had longer duration of non-invasive ventilation[(37.8±19.6)d vs.(24.2±13.0)d],higher incidence of BPD(75.6%vs.30.3%),longer hospital stay,[85.0(71.0,102.5)d vs.64.0(53.0,76.0)d]and more home-based oxygen therapy(22.4%vs.7.0%)(P<0.05).The duration of mechanical ventilation in<28 w group was 10.0(1.3,29.0)d and 4.7(2.2,10.3)d in≥28 w group.Conclusion Most ELBW infants need tracheal intubation after birth.The infants with smaller GA need longer duration of respiratory support and have higher incidence of long-term complications of respiratory tract.
作者
李帅军
冯琪
童笑梅
李秋平
王俊怡
王亚娟
刘卫鹏
曾超美
王丹华
赵文利
李丽华
崔红
黑明燕
王晓颖
张雪峰
郭九叶
杨明
Li Shuaijun;Feng Qi;Tong Xiaomei;Li Qiuping;Wang Junyi;Wang Yajuan;Liu Weipeng;Zeng Chaomei;Wang Danhua;Zhao Wenli;Li Lihua;Cui Hong;Hei Mingyan;Wang Xiaoying;Zhang Xuefeng;Guo Jiuye;Yang Ming(Department of Pediatrics,Peking University First Hospital,Beijing 100034,China;Department of Pediatrics,Peking University Third Hospital,Beijing 100191,China;Department of Neonatology,BaYi Children's Hospital,The Seventh Medical Center of PLA General Hospital,Beijing 100700,China;Department of Pediatrics,The First Hospital of Tsinghua University,Beijing 100016,China;Department of Neonatology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100020,China;Department of Neonatology,The Sixth Medical Center of PLA General Hospital,Beijing 100048,China;Department of Pediatrics,Peking University People's Hospital,Beijing 100044,China;Department of Pediatrics,Peking Union Medical College Hospital,Beijing 100730,China;Department of Gynecology and Pediatrics,PLA Rocket Force Characteristic Medical Center,Beijing 100032,China;Department of Pediatrics,Beijing Luhe Hospital,Capital Medical University,Beijing 101100,China;Department of Pediatrics,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Neonatal Center,Beijing Children's Hospital,Capital Medical University,Beijing 100045,China;Department of Neonatology,Children's Hospital,Capital Institute of Pediatrics,Beijing 100020,China;Department of Pediatrics,The Fifth Medical Center of PLA General Hospital,Beijing 100071,China;Department of Pediatrics,Chaoyang Maternal and Child Health Hospital of Beijing,Beijing 100020,China;Department of Pediatrics,Beijing United Family Hospital,Beijing 100015,China)
关键词
婴儿
早产
婴儿
超低出生体重
复苏
呼吸支持
支气管肺发育不良
Infant,premature
Infant,extremely low birth weight
Resuscitation
Respiratory therapy
Bronchopulmonary dysplasia
