中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2008年
9期
654-657
,共4页
呼吸窘迫综合征,新生儿%婴儿,新生%婴儿,早产%呼吸,人工
呼吸窘迫綜閤徵,新生兒%嬰兒,新生%嬰兒,早產%呼吸,人工
호흡군박종합정,신생인%영인,신생%영인,조산%호흡,인공
Respiratory distress syndrome,newborn%Infant,newborn%Infant,premature%Respiration,artificial
目的 比较晚期早产儿或足月儿和早产儿呼吸窘迫综合征(respiratory distress syndrome,RDS)的特点,探讨晚期早产儿或足月儿RDS的临床特征和发病机理.方法 2005年5月至2007年5月,在本院住院177例RDS患儿,＜35周为早产组,103例,≥35周为晚期早产儿或足月儿组,74例.结果 早产组开始应用呼吸机时间为8.7 h,持续应用呼吸机时间4.3 d,氧合指数(Oxygenation index,OI)11.9,PaO2/PAO2 0.29,有28例应用表面活性物质(pulmonary surfactant,PS),其中11例应用呼吸机,应用PS前及后2 h、8～12 h、20～24 h OI分别为10.5、5.4、3.4、4.3(P＜0.01).晚期早产儿或足月儿组开始应用呼吸机时间为27.8 h(与早产组比,下同,P＜0.01),持续应用呼吸机时间3.7 d,OI 19.70(P＜0.01),PaO2/PAO20.16(P＜0.01),8例应用PS中有7例应用呼吸机,应用PS前及后2 h,8～12 h、20～24 h OI分别为11.2、7.6、7.5、7.6(其中8～12 h、20～24 h OI与早产组比,P均＜0.05).结论 晚期早产儿或足月儿RDS患儿以产程未发动的剖宫产为主.开始应用呼吸机时间较晚,氧合情况较差,表面活性物质应用效果较差,易发生气胸和PPHN.
目的 比較晚期早產兒或足月兒和早產兒呼吸窘迫綜閤徵(respiratory distress syndrome,RDS)的特點,探討晚期早產兒或足月兒RDS的臨床特徵和髮病機理.方法 2005年5月至2007年5月,在本院住院177例RDS患兒,＜35週為早產組,103例,≥35週為晚期早產兒或足月兒組,74例.結果 早產組開始應用呼吸機時間為8.7 h,持續應用呼吸機時間4.3 d,氧閤指數(Oxygenation index,OI)11.9,PaO2/PAO2 0.29,有28例應用錶麵活性物質(pulmonary surfactant,PS),其中11例應用呼吸機,應用PS前及後2 h、8～12 h、20～24 h OI分彆為10.5、5.4、3.4、4.3(P＜0.01).晚期早產兒或足月兒組開始應用呼吸機時間為27.8 h(與早產組比,下同,P＜0.01),持續應用呼吸機時間3.7 d,OI 19.70(P＜0.01),PaO2/PAO20.16(P＜0.01),8例應用PS中有7例應用呼吸機,應用PS前及後2 h,8～12 h、20～24 h OI分彆為11.2、7.6、7.5、7.6(其中8～12 h、20～24 h OI與早產組比,P均＜0.05).結論 晚期早產兒或足月兒RDS患兒以產程未髮動的剖宮產為主.開始應用呼吸機時間較晚,氧閤情況較差,錶麵活性物質應用效果較差,易髮生氣胸和PPHN.
목적 비교만기조산인혹족월인화조산인호흡군박종합정(respiratory distress syndrome,RDS)적특점,탐토만기조산인혹족월인RDS적림상특정화발병궤리.방법 2005년5월지2007년5월,재본원주원177례RDS환인,＜35주위조산조,103례,≥35주위만기조산인혹족월인조,74례.결과 조산조개시응용호흡궤시간위8.7 h,지속응용호흡궤시간4.3 d,양합지수(Oxygenation index,OI)11.9,PaO2/PAO2 0.29,유28례응용표면활성물질(pulmonary surfactant,PS),기중11례응용호흡궤,응용PS전급후2 h、8～12 h、20～24 h OI분별위10.5、5.4、3.4、4.3(P＜0.01).만기조산인혹족월인조개시응용호흡궤시간위27.8 h(여조산조비,하동,P＜0.01),지속응용호흡궤시간3.7 d,OI 19.70(P＜0.01),PaO2/PAO20.16(P＜0.01),8례응용PS중유7례응용호흡궤,응용PS전급후2 h,8～12 h、20～24 h OI분별위11.2、7.6、7.5、7.6(기중8～12 h、20～24 h OI여조산조비,P균＜0.05).결론 만기조산인혹족월인RDS환인이산정미발동적부궁산위주.개시응용호흡궤시간교만,양합정황교차,표면활성물질응용효과교차,역발생기흉화PPHN.
Objective Respiratory distress syndrome(RDS)is a frequently seen acute respiratory disorder in the newborn infants.Since the original description of deftciency of the pulmonary sudactant in premature neonates by Avery in 1959,RDS has most commonly been attributed to developmental immaturity of surfactant production.But in clinicnl practice it has been found that there was RDS in term and late-term neonates.Many of them were recognized as transient tachypnea at the beginning.they were diagnosed as RDS until respiratory distress and the typical radiologienl signs were demonstrated.The purpose of this study was to investigate the clinical characteristics of RDS of term and late.term neonates.Methods All neonates admitted to the neonatal intensive care unit of the Children's Hospital.Zhejiang University School of Medicine between May.2005 and May,2007 on the basis of RDS were analyzed.RDS was diagnosed when respiratory distress and the typical radiological signs were documented.Patients were grouped into preterm group(Group 1,gestational age＜35 w,n=103)and term and late-term group(Group 2,gestational age ≥35 w,n=74).Results In Group 1,76 preterm infants were male,the mean gestational age was 31.1 w,the mean Apgar score at 1 min was 7.6,the mean birth weight was 1702 g,56 cases were vaginally delivered and 47 were delivered through Cesarean secfiorL Only one was delivered via elective Cesarean.section before onset of labor.A total of 88 patients needed mechanical ventilation(MV),the time for beginning MV wag 8.7 h(1-72 h),and lasted for 4.3 d(0.5-29 d).The oxygenation index(OI)was 11.9(10.00-52.63)and PaO2/PAO2 was 0.29(0.03-0.98).Four patients had an OI＞40.A total of 28 patients were treated with pulmonary surfactant(PS),and 11 of the 28 underwent MV,the OI before and 2 h,8-12 h and 20-24 h after using PS were 10.5,5.4,3.4,and4.3,respectively(P＜0.01).A total of 33 patients in Group 1 had intraeranial hemorrhage,4 patients had pneumothorax,4 patients had persistent pulmonary hypertension of the newbern(PPHN)and 15 patients had ventilator associated pneumonia (VAP).In Group 2,54 infants were male,the mean gestational age was 37 w,the mean Apgar score at 1 min was 8.5,the mean birth weight was 2789 g,8 cases were vaginally delivered.66 were delivered thrush Cesarean section and 59 were delivered via elective Cesarean section before onset of labor.A total of 63 patients needed MV,the time for beginning MV was 27.8 h(1-72 h,compared to Group 1,P＜0.01),and lasted for 3.7 d(0.5-13.5 d).The OI was 19.70(10.00-56.67,compared to Group 1,P＜0.01)and PaO2/PAO2 was 0. 16 (0. 017-0. 470,compared to Group 1,P ＜0. 01 ). Seven patients had an OI ＞40. A total of 8 patients were treated with PS and7 of them had MV,the OI before and2 h,8-12 h and 20 - 24 h after using PS were 11.2,7.6,7.5,and 7. 6 ( the last two compared to group 1,P ＜ 0. 01,respectively). A total of 16 patients had pneumothorax,10 patients had intracranial hemorrhage,16 patients had PPHN and 7 patients had VAP. Conclusion Most of the term and late-term neonates who developed RDS were delivered through cesarean section before onset of labor. They underwent MV later. The oxygenation was worse than RDS in preterm infants. PS did not have the same effect as seen in preterm infants. They had more pneumothorax and PPHN.
