CAJ | 학술논문

目的：分析不同胎龄段早产儿呼吸窘迫综合征（ RDS）的临床特点，为临床合理诊治提供依据。方法2012年6月至2013年12月在北京大学深圳医院新生儿病房131例早产并新生儿呼吸窘迫综合征（NRDS）患儿根据胎龄不同分为早期组（小于34周）92例，晚期组（34～37周）39例，分别对两组患儿入院时一般情况、分娩方式、胸片特点、治疗情况进行比较。结果两组在男婴比、窒息率、孕母高危因素等一般情况均无显著差异（P＞0．05）；分娩方式上，晚期组剖宫产率高达84．6％，显著高于早期组（P＜0．05）；胸片特点上，晚期组更多表现为非匀质性透亮度减低或者肺容积不减少，占61．5％，较早期组18．4％有显著差异（P＜0．01）；在治疗方面，晚期组总体PS使用率虽低于早期组（P＜0．05），但需大剂量PS或重复PS使用率反而增高（P＜0．01），相应地，晚期组依赖有创机械通气支持率及RDS并发症率均较早期组高（P＜0．05），但经过积极治疗，两组救治成功率均高达90％以上，死亡率在组间无显著差异（P＞0．05）。结论 RDS的诊治需要考虑胎龄因素，两组在一般情况方面无明显差异，但晚期组治疗上更依赖于大剂量PS及机械通气使用，并发症多，经积极治疗后，死亡率和早期组则无明显差异。
목적：분석불동태령단조산인호흡군박종합정（ RDS）적림상특점，위림상합리진치제공의거。방법2012년6월지2013년12월재북경대학심수의원신생인병방131례조산병신생인호흡군박종합정（NRDS）환인근거태령불동분위조기조（소우34주）92례，만기조（34～37주）39례，분별대량조환인입원시일반정황、분면방식、흉편특점、치료정황진행비교。결과량조재남영비、질식솔、잉모고위인소등일반정황균무현저차이（P＞0．05）；분면방식상，만기조부궁산솔고체84．6％，현저고우조기조（P＜0．05）；흉편특점상，만기조경다표현위비균질성투량도감저혹자폐용적불감소，점61．5％，교조기조18．4％유현저차이（P＜0．01）；재치료방면，만기조총체PS사용솔수저우조기조（P＜0．05），단수대제량PS혹중복PS사용솔반이증고（P＜0．01），상응지，만기조의뢰유창궤계통기지지솔급RDS병발증솔균교조기조고（P＜0．05），단경과적겁치료，량조구치성공솔균고체90％이상，사망솔재조간무현저차이（P＞0．05）。결론 RDS적진치수요고필태령인소，량조재일반정황방면무명현차이，단만기조치료상경의뢰우대제량PS급궤계통기사용，병발증다，경적겁치료후，사망솔화조기조칙무명현차이。
Objective To analyze clinical features of different gestational age preterm children with respiratory distress syndrome ( RDS) to provide the basis for clinical diagnosis and treatment .Methods 131 cases of premature birth and neonatal respiratory distress syndrome ( NRDS) between June 2012 and December 2013 extracted from Peking University Shenzhen Hospital neonatal ward , were divided into early group ( <34 weeks)92 cases, later group (34~37 weeks) 39 cases according to gestational age infants .The comparison of general admission , mode of delivery , prematurity causes , chest X-ray characteristics , treatment were offered between the two groups of children .Results There was no statistically different proportions in risk factors of intrauterine infection,maternal combined gestational diabetes ,birth asphyxia, sex ratio(P>0.05).Early group was 66.3%of cesarean section and advanced group was 84.6%, there was significantly different between the two groups(P<0.05).From the chest X-ray features, later group showed more performance of non-homogeneity reduction of density shadow and less reduction in lung volume than early group (P<0.01).The later group using treatment with Curosurf didn't show more obvious effect , the time assisted ventilation was longer , the complication was more than early group ( P<0.05) .Conclusions The diagnosis and treatment of RDS needs to consider gestational age , NRDS factors of early group may be the reduction of the principal of PS , so the condition is relatively simple , the Curosurf treatment is more ideal .The possible cause of the rise of PS consumption or the reduction in activity lead to disease complex once NRDS appears in later group .So we need to be alert to whether the merger of serious complications , most need early enough Curosurf , strong anti-infection , pulmonary artery pressure drop in time, if necessary, early mechanical ventilation.