摘要
目的探讨不同胎龄新生儿呼吸窘迫综合征(RDS)的高危因素及临床特点。方法于2012年2月至2015年2月攀钢集团总医院儿科确诊为RDS的新生儿中选取50例出生胎龄<34周的新生儿作为早期早产组,45例出生胎龄为34~36周的新生儿作为晚期早产组,45例出生胎龄≥37周的新生儿作为足月产组。回顾性分析各组新生儿基本临床资料,对引发RDS的高危因素及临床特点进行分析。结果早期早产组出生窒息史(66.0%)、不明原因早产(44.0%)显著高于晚期早产组(24.0%、13.3%),孕母高血压发生率(4.0%)显著低于晚期早产组(20.0%),多胎妊娠(10.0%)、出生窒息史(66.0%)、不明原因早产(44.0%)、胎膜早破(28.00%)发生率显著高于足月产组(0、17.8%、2.2%、2.2%),孕母糖尿病(4.0%)、剖宫产发生率(54.0%)显著低于足月产组(37.8%、97.8%)。晚期早产组孕母高血压(20.0%)、胎膜早破(22.2%)、不明原因早产发生率(13.3%)显著高于足月产组(4.4%、2.2%、2.2%),孕母糖尿病发生率(8.9%)显著低于足月产组(37.8%)(P<0.05)。早期早产组肺部感染(52.0%)、白肺发生率(28.0%)显著高于晚期早产组(17.8%、0),肺部感染(52.0%)、颅内出血(26.0%)、支气管肺发育不良(20.0%)、白肺发生率(28.0%)显著高于足月产组(6.8%、2.2%、0、0)。晚期早产组颅内出血(13.3%)、支气管肺发育不良发生率(4.9%)显著高于足月产组(2.2%、0)(P<0.05)。早期早产组使用机械通气(26.0%)、肺部表面活性物质患者比例(88.0%)显著高于晚期早产组(0、44.4%),使用肺部表面活性物质患者比例(88.0%)显著高于足月产组(46.7%)。晚期早产组使用机械通气患者比例(0)显著低于足月组(33.3%)(P<0.05)。结论不同胎龄患者并发症、高危因素各异,RDS多发于早产儿,且具有并发症多,病情重等临床特点,故治疗时需考虑新生儿胎龄因素。且足月儿发生RDS的高危因素为剖宫产、孕妇高血压等,故应严格掌握剖宫产指征。
Objective To explore the risk factors and clinical features of neonatal respiratory distress syndrome( RDS) of different gestational ages. Methods From Feb. 2012 to Feb. 2015 in Pediatrics Department of General Hospital of Panzhihua Iron and Steel Group newborns with RDS of different gestational ages were selected,including 50 cases of gestational age < 34 weeks as early preterm birth group,45 cases of gestational age is 34-36 weeks as late preterm group,45 cases of gestational age of 37 weeks as full-term group. The basic clinical data of all groups were retrospectively analyzed,and high risk factors and clinical characteristics of RDS were analyzed.Results The history of birth asphyxia( 66. 0%) and unknown causes premature birth( 44. 0%) of the early preterm birth group were significantly higher than the late preterm group( 24. 0%,13. 3%),the incidence of motherhood hypertension( 4. 0%) was significantly lower than the late preterm group( 20. 0%),multiple pregnancies( 10. 0%),birth asphyxia history( 66. 0%),unexplained preterm birth( 44. 0%),premature rupture of membranes( 28. 0%) were significantly higher than the full-term group( 0,17. 8%,2. 2%,17. 8%). The motherhood diabetes( 4. 0%),the incidence of Cesarean section( 54. 0%) of the late preterm group were significantly lower than the full-term group( 37. 8%,97. 8%). The motherhood hypertension( 20. 0%),premature rupture of membranes( 22. 2%) and unknown causes premature birth incidence( 13. 3%) of the late preterm group were significantly higher than the full-term group( 4. 4%,2. 2%,2. 2%),motherhood diabetes incidence( 8. 9%) was significantly lower than the full-term group( 37. 8%)( P < 0. 05). The incidence of pulmonary infection( 52. 0%),white lung( 28. 0%) of the early preterm group were significantly higher than the late preterm group( 17. 8%,0); and the pulmonary infection( 52. 0%),intracranial hemorrhage( 26. 0%),bronchial pulmonary dysplasia( 20. 0%),white lung( 28. 0%) were significantly higher than the full-term group( 6. 8%,2. 2%,0,0). The intracranial hemorrhage( 13. 3%),bronchial pulmonary dysplasia( 4. 9%) of the later preterm group were significantly higher than the full-term group( 2. 2%,0)( P < 0. 05). The mechanical ventilation application( 26. 0%),lung surface active substance proportion( 88. 0%) of the early preterm group were significantly higher than the late preterm group( 0,44. 4%),lung surface active substance proportion( 88. 0%) was significantly higher than the full-term group( 46. 7%). The mechanical ventilation application of the late preterm group( 0) was significantly lower than the full-term group( 33. 3%)( P < 0. 05). Conclusion Complications and risk factors in infants with different gestational ages are varied,and RDS is frequently seen in premature infants with the features of more complications and serious condition,so gestational age factor should be considered in treatment. And high risk factors of RDS in full-term babies include Cesarean section delivery,gestational hypertension etc.,therefore the Cesarean section delivery indicatros must be strictly mastered.
出处
《医学综述》
2016年第10期2024-2027,共4页
Medical Recapitulate
关键词
呼吸窘迫综合征
新生儿
不同胎龄
高危因素
Respiratory distress syndrome
The newborn
Different gestational ages
Risk factors
