CAJ | 학술논문

目的研究不同年代影响新生儿肺动脉高压发生的临床病因与病情发展的关系.方法回顾性分析2006年6月至2012年5月北京儿童医院NICU收治的169例肺动脉高压患儿的临床资料,按时间顺序分为前期组79例(2006年6月至2009年5月)及后期组90例(2009年6月至2012年5月),分别统计患儿的性别、胎龄、原发病、心脏超声检查情况.分析不同年代肺动脉高压患儿的主要临床病因及病情.结果前期组入院时间(2.15±1.2)d,晚于后期组(1.41±0.7)d;前期组原发病中胎粪吸入综合征25例(31.6％),后期组14例(15.6％),两组差异有统计学意义(P＜0.05).其他原发病如先天性膈疝、新生儿呼吸窘迫综合征、吸人性肺炎、湿肺、新生儿感染性肺炎/败血症、新生儿窒息两组间差异无统计学意义(P＞0.05).前期组早产儿11例(13.9％),后期组早产儿23例(25.6％),两者间差异有统计学意义(P＜0.05).足月儿与过期产儿两组间差异无统计学意义(P＞0.05).入院后进行床边超声心动图检查,轻度及中度肺动脉高压两组差异无统计学意义(P＞0.05).发生重度肺动脉高压的患儿前期组较后期组明显增多(26例vs 17例).结论随着我国围生期监测及产时复苏技术的提高,由胎粪吸入综合征引起的肺动脉高压并转入上级医院救治的患儿有所减少.早产儿中发生肺动脉高压的比例有所增加,肺动脉高压患儿转入NICU的时间缩短,从而发生重度肺动脉高压的患儿相对减少,给治疗及改善预后提供了有力支持.
목적 연구불동년대영향신생인폐동맥고압발생적림상병인여병정발전적관계.방법 회고성분석2006년6월지2012년5월북경인동의원NICU수치적169례폐동맥고압환인적림상자료,안시간순서분위전기조79례(2006년6월지2009년5월)급후기조90례(2009년6월지2012년5월),분별통계환인적성별、태령、원발병、심장초성검사정황.분석불동년대폐동맥고압환인적주요림상병인급병정.결과 전기조입원시간(2.15±1.2)d,만우후기조(1.41±0.7)d;전기조원발병중태분흡입종합정25례(31.6％),후기조14례(15.6％),량조차이유통계학의의(P＜0.05).기타원발병여선천성격산、신생인호흡군박종합정、흡인성폐염、습폐、신생인감염성폐염/패혈증、신생인질식량조간차이무통계학의의(P＞0.05).전기조조산인11례(13.9％),후기조조산인23례(25.6％),량자간차이유통계학의의(P＜0.05).족월인여과기산인량조간차이무통계학의의(P＞0.05).입원후진행상변초성심동도검사,경도급중도폐동맥고압량조차이무통계학의의(P＞0.05).발생중도폐동맥고압적환인전기조교후기조명현증다(26례vs 17례).결론 수착아국위생기감측급산시복소기술적제고,유태분흡입종합정인기적폐동맥고압병전입상급의원구치적환인유소감소.조산인중발생폐동맥고압적비례유소증가,폐동맥고압환인전입NICU적시간축단,종이발생중도폐동맥고압적환인상대감소,급치료급개선예후제공료유력지지.
Objective To discuss the relationship between the clinical pathogenesis and progression in neonatal pulmonary hypertension in different stages.Methods Total 169 cases of pulmonary hypertension were admitted in our NICU from June 2006 to May 2012,all the cases were involved in this retrospective study.They were divided into two groups in chronological order:early group 79 cases (from June 2006 to May 2009) and late group 90 cases (from June 2009 to May 2012).The data records include gender,gestational age,protopathy,echocardiography examination results.Furthermore,the cause and development of neonatal pulmonary hypertension were analyzed in different stages.Results The admission time in the early group was later than the late group [(2.15 ± 1.2) d vs (1.41 ±0.70) d].Meconium aspiration syndrome in the early group were 25 cases (31.6％) and the late group were 14 cases (15.6％).Other complications,such as congenital diaphragmatic hernia,neonatal respiratory distress syndrome,aspiration pneumonia,wet lung/sepsis,neonatal asphyxia,neonatal infectious pneumonia had no difference between the two groups(P ＞0.05).Neonatal pulmonary hypertension in two groups had no statistical difference between term and post term patients,but premature in the early group (11 cases,13.9％) were less than the late group (23 cases,25.6％).Echocardiography was recorded after admission,mild and moderate pulmonary hypertension had no statistical differences in the two groups (P ＞ 0.05).The severe pulmonary hypertension cases in the early group were more than those in the late group (26 cases vs 17 cases).Conclusion Along with the improvement of perinatal monitoring and resuscitation technology in different stages,the cases of meconium aspiration syndrome with pulmonary hypertension are fallen down and the patients transferred to the superior hospital decreased.The amount of pulmonary hypertension in preterm infants increases,and the admission time of patients with neonatal pulmonary hypertension are shortened.The amount of severe pulmonary hypertension are less than those in the early time.It plays a positive role in best approach to improving treatment and outcomes.