中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2010年
2期
119-122
,共4页
婴儿,新生,胎儿%肺出血%病因%死因
嬰兒,新生,胎兒%肺齣血%病因%死因
영인,신생,태인%폐출혈%병인%사인
Infant,newbom%Fetus%Pulmonary hemorrhage%Pathogenesis%Death cause
目的 探讨出生24h内新生儿肺出血的病因与死因,并推测其与胎儿肺出血的关系.方法 选择114例出生24h内即发生肺出血的新生儿,根据临床与病理资料进行分析.结果 114例患儿的肺部病理检查结果,点状肺出血6例,局灶性肺出血印例,弥漫性肺出血48例.28例于生后0～6h,71例于生后7～12h,15例于生后13～24h内发病.肺出血病因中缺氧因素110例,包括吸入性肺炎62例、呼吸窘迫综合征24例、青紫型复杂心脏畸形7例、肺膨胀不全7例、新生儿窒息7例、其他原因缺氧3例;感染因素4例,病因均为宫内感染所致败血症.肺出血患儿死亡因素中缺氧因素113例,包括肺出血74例、吸人性肺炎15例、呼吸窘迫综合征12例、青紫型复杂心脏畸形7例、肺膨胀不全2例、颅内出血2例、新生儿窒息1例;感染因素I例,为宫内感染所致败血症.82例有宫内窘迫史,在直接死于肺出血的74例中,3例有宫内窘迫史,且出生数分钟即死亡.结论 出生24 h内新生儿肺出血病因及死因均以缺氧因素为主,大多有宫内窘迫.其中3例弥漫性肺出血患儿于出生数分钟即死亡,从而推测出生24h内新生儿肺出血,有相当部分可能为胎儿肺出血的延续.
目的 探討齣生24h內新生兒肺齣血的病因與死因,併推測其與胎兒肺齣血的關繫.方法 選擇114例齣生24h內即髮生肺齣血的新生兒,根據臨床與病理資料進行分析.結果 114例患兒的肺部病理檢查結果,點狀肺齣血6例,跼竈性肺齣血印例,瀰漫性肺齣血48例.28例于生後0～6h,71例于生後7～12h,15例于生後13～24h內髮病.肺齣血病因中缺氧因素110例,包括吸入性肺炎62例、呼吸窘迫綜閤徵24例、青紫型複雜心髒畸形7例、肺膨脹不全7例、新生兒窒息7例、其他原因缺氧3例;感染因素4例,病因均為宮內感染所緻敗血癥.肺齣血患兒死亡因素中缺氧因素113例,包括肺齣血74例、吸人性肺炎15例、呼吸窘迫綜閤徵12例、青紫型複雜心髒畸形7例、肺膨脹不全2例、顱內齣血2例、新生兒窒息1例;感染因素I例,為宮內感染所緻敗血癥.82例有宮內窘迫史,在直接死于肺齣血的74例中,3例有宮內窘迫史,且齣生數分鐘即死亡.結論 齣生24 h內新生兒肺齣血病因及死因均以缺氧因素為主,大多有宮內窘迫.其中3例瀰漫性肺齣血患兒于齣生數分鐘即死亡,從而推測齣生24h內新生兒肺齣血,有相噹部分可能為胎兒肺齣血的延續.
목적 탐토출생24h내신생인폐출혈적병인여사인,병추측기여태인폐출혈적관계.방법 선택114례출생24h내즉발생폐출혈적신생인,근거림상여병리자료진행분석.결과 114례환인적폐부병리검사결과,점상폐출혈6례,국조성폐출혈인례,미만성폐출혈48례.28례우생후0～6h,71례우생후7～12h,15례우생후13～24h내발병.폐출혈병인중결양인소110례,포괄흡입성폐염62례、호흡군박종합정24례、청자형복잡심장기형7례、폐팽창불전7례、신생인질식7례、기타원인결양3례;감염인소4례,병인균위궁내감염소치패혈증.폐출혈환인사망인소중결양인소113례,포괄폐출혈74례、흡인성폐염15례、호흡군박종합정12례、청자형복잡심장기형7례、폐팽창불전2례、로내출혈2례、신생인질식1례;감염인소I례,위궁내감염소치패혈증.82례유궁내군박사,재직접사우폐출혈적74례중,3례유궁내군박사,차출생수분종즉사망.결론 출생24 h내신생인폐출혈병인급사인균이결양인소위주,대다유궁내군박.기중3례미만성폐출혈환인우출생수분종즉사망,종이추측출생24h내신생인폐출혈,유상당부분가능위태인폐출혈적연속.
Objective To investigate the pathogenesis and death cause of neonatal pulmonary hem orrhage (NPH) within postnatal 24 h and speculate their relation to fetal pulmonary hemorrhage. Methods To select the 114 cases of NPH within postnatal 24 h confirmed by pathological examination. According to the pathologic and clinic diagnosis materials, the pathogenesis and death cause of NPH within postnatal 24 h and their relation to fetal pulmonary hemorrhage were analyzed. Results Of the 114 cases with NPH,there were 6 cases of petechial pulmonary hemorrhage,60 cases of focal pulmonary hemorrhage and 48 cases of diffuse pulmonary hemorrhage. The discovery time of NPH were 28 cases at 0～6 h ,71 cases at 7～12 h and 15 cases at 13～24 h after birth. The pathogenesis in 114 cases of NPH could be divided into identical 2 major factors: 110 cases of the oxygen deficient factor consisting of amniotic fluid aspiration pneumonia( 62 cases) .hyaline membrane disease(24 cases) .complexity cyanotic congenital heart disease(7 cases),congenital pulmonary a-genesis(7 cases),neonatal asphyxia (7 cases),intracranial hemorrhage(2 cases) and hypoxic ischemic en-cephalopathy(1 cases) .respectively. Four cases were due to infection including sepsis which was caused by intrauterine infection. The death causes in 114 cases of NPH included hypoxia (113 cases) which consisted of pulmonary hemorrhage (74 cases) .amniotic fluid aspiration pneumonia(15 cases) .hyaline membrane dis-ease(12 cases),complexity cyanotic congenital heart disease(7 cases),congenital pulmonary agenesis(2 ca-ses) ,intracranial hemorrhage(2 cases) .neonatal asphyxia (1 cases) .and infectious factor(1 case) of sepsis which was caused by intrauterine infection. In 114 cases,82 cases had fetal distress,74 cases died from NPH directly including 3 cases with fetal distress died within a few minutes after birth. Conclusion Oxygen defi-cient is an important factor in pathogenesis and death cause of NPH within postnatal 24 h. The majority of ca-ses have the fetal distress and died from NPH directly in short time. Because of 3 cases NPH died within a few minutes after birth, therefore we conjecture that the most cases of NPH within postnatal 24 h may be a ex-tension of fetal pulmonary hemorrhage.
