不同胎龄新生儿呼吸窘迫综合征临床特征分析

《浙江医学》网站地址

：w w w .z j y x z z s .c o m 浙江医学2017年第39卷第21期

新生儿呼吸窘迫综合征（neonatal respiratory dis 原tress syndrome ，NRDS ）又称肺透明膜病，是由于肺表面活性物质（PS ）缺乏或失活引起的，其临床特征为生后不久出现呼吸窘迫并进行性加重，多见于早产儿或低体重儿。X 线是目前诊断NRDS 的最佳手段，影像学可表现为毛玻璃样改变，支气管充气征，白肺，肺容量减少。近年研究发现，超声检查也可辅助诊断NRDS ，并且可以帮助评估呼吸窘迫是否需要机械通气支持[1-3]。早产儿因肺的发育尚未完善，故容易发生NRDS 。而晚期早产儿肺发育已基本成熟，但近年来其发生NRDS 的比例逐渐增高，故其病因、机制及治疗成为目前临床上研究的热杜勇钱燕陈新

不同胎龄新生儿呼吸窘迫综合

征临床特征分析

doi ：10.12056/j.issn.1006-2785.2017.39.21.2017-637作者单位：325000温州医科大学附属第一医院儿科（杜勇、钱燕），消化科（陈新）通信作者：陈新，E-mail ：duyong860320@https://www.wendangku.net/doc/417754568.html, 【摘要】目的探讨分析不同胎龄新生儿呼吸窘迫综合征（NRDS ）的临床特征及主要危险因素。方法收集NRDS 早产儿122例，按胎龄将早产儿分为两组：＜34周为早期早产儿组（93例），34～＜37周为晚期早产儿组（29例）。比较两组NRDS 早产儿一般情况、围生期高危因素、治疗情况及合并症发生情况。结果两组早产儿机械通气、同步间歇指令通气（SIMV ）、经鼻持续气道正压通气（nCPAP ）例数及机械通气时间、SIMV 时间、nCPAP 时间比较差异均无统计学意义（均P ＞0.05）。早期早产儿组一般氧疗、总氧疗及住院时间要长于晚期早产儿组，差异均有统计学意义（均P ＜0.05）。晚期早产儿组NRDS 病情更重，重复使用肺表面活性物质率要高于早期早产儿组，差异有统计学意义（P ＜0.05）。早期早产儿组肺部感染、支气管肺发育不良、败血症、输血发生率均高于晚期早产儿组，差异均有统计学意义（均P ＜0.05）。两组早产儿颅内出血、动脉导管未闭、心功能不全、气胸发生率比较差异均无统计学意义（均P ＞0.05）。结论NRDS 的发生以早期早产儿为主，不同胎龄NRDS 患儿的发病特点、合并症及治疗反应均存在差异，因此在诊断和治疗时应考虑胎龄因素，从而为指导临床诊疗，采取更合理的防治方案提供依据。

【关键词】早产儿呼吸窘迫综合征胎龄临床特征

Clinical features of neonatal respiratory distress syndrome in newborns of different gestational age

China

【Abstract 】Objective To investigate clinical characteristics and risk factor of neonatal respiratory distress syndrome

(NRDS)in newborns of different gestational age.

Methods Clinical data of 122newborns with neonatal respiratory distress syndrome were retrospectively analyzed,including 93cases with gestational age ＜34weeks (early preterm group)and 29cases with gestational age ＜37weeks (late preterm group).The basic conditions,perinatal high risk factors,treatment and complications of the two groups were compared.Results There were no significant differences in durations of mechanical ventilation,synchronized intermittent mandatory ventilation (SIMV)and nasal continuous positive airway pressure (nCPAP)between two groups(all P ＞0.05).But the time of oxygen therapy and the length of hospital stay in early preterm group was longer than those in late preterm group (all P ＜0.05).The condition of NRDS was more serious and the requirement of reuse pulmonary surfactant was more common in late preterm group than those in early preterm group (P ＜0.05).The risks of pulmonary infection,bronchopulmonary dysplasia,septicemia and blood transfusion in early preterm infants were higher than those in late preterm group(all P ＜0.05).But there were no significant differences in the incidence of intracranial hemorrhage,patent ductus arteriosus,cardiac insufficiency and pneumothorax between the two groups (all P ＞0.05).

Conclusion NRDS predominantly occurs in early preterm infants.The clinical characteristics,complications and treatment responses of NRDS with different gestational age are different.So gestational age should be considered for diagnose and treatment.

【Key words 】Preterm infants Neonatal respiratory distress syndrome Gestational age Clinical feature