中国妇幼健康研究
中國婦幼健康研究
중국부유건강연구
CHINESE JOURNAL OF MATERNAL AND CHILD HEALTH RESEARCH
2015年
3期
402-405
,共4页
张娟%刘俐%王全丽%李占魁%付慧玲%周卫平%张月萍%万彩红%李和勤%李文君%贺波%宋文萍%刘晓会%张燕妮
張娟%劉俐%王全麗%李佔魁%付慧玲%週衛平%張月萍%萬綵紅%李和勤%李文君%賀波%宋文萍%劉曉會%張燕妮
장연%류리%왕전려%리점괴%부혜령%주위평%장월평%만채홍%리화근%리문군%하파%송문평%류효회%장연니
新生儿%呼吸窘迫综合征%表面活性物质%流行病学
新生兒%呼吸窘迫綜閤徵%錶麵活性物質%流行病學
신생인%호흡군박종합정%표면활성물질%류행병학
neonates%respiratory distress syndrome ( RDS)%pulmonary surfactant ( PS)%epidemiology
目的：调查陕西省新生儿呼吸窘迫综合征( RDS)的诊治现状,探讨本地区RDS诊疗过程中的问题及对策。方法采用描述性流行病学调查方法,回顾性调查陕西省内12家医院新生儿病房于2011年1月1日至12月31日所有诊断为RDS的患儿,收集全部病例的基本情况、围产期、临床表现及治疗、并发症及预后等情况。并且按医疗机构所在地分为以省会城市西安组及其他地市组进行比较。结果参与调查的12家医院2011年新生儿科共收治患儿9994例,RDS患儿366例,占新生儿收治总数的3.7%。常见的围产期高危因素依次为：低Apgar评分23.5%,多胎20.5%,妊娠期高血压17.8%,胎膜早破14.8%,胎盘早剥3.6%,妊娠期糖尿病2.2%。西安组的产前激素使用率(9.2%)低于地市组(10.0%),χ2=42.899,P <0.05；剖宫产率(71.1%)高于地市组(41.7%),χ2=37.843,P<0.05；西安组表面活性物质(PS)使用早(u=4.104,P<0.05)、INSURE技术及辅助通气使用率高(χ2值分别为9.206、6.461,均P<0.05)、辅助通气时间短(u=1.965,P<0.05),地市组平均住院时间低于西安组(u=3.732,P<0.05)。常见并发症依次为：脑室内出血10.7%、肺出血3.4%、导管未闭3.2%、支气管肺发育不良2.4%、坏死性小肠结肠炎2.1%、脑室旁白质软化2.1%、肺气漏0.9%。 RDS患儿总病死率为8.2%(30/366)。结论陕西省RDS的救治应继续规范产前糖皮质激素治疗、降低剖宫产率预防RDS发生,与省会城市相比其他地区PS使用仍不足,出生后尽早、足量使用PS及INSURE技术是本省急需解决的问题。
目的：調查陝西省新生兒呼吸窘迫綜閤徵( RDS)的診治現狀,探討本地區RDS診療過程中的問題及對策。方法採用描述性流行病學調查方法,迴顧性調查陝西省內12傢醫院新生兒病房于2011年1月1日至12月31日所有診斷為RDS的患兒,收集全部病例的基本情況、圍產期、臨床錶現及治療、併髮癥及預後等情況。併且按醫療機構所在地分為以省會城市西安組及其他地市組進行比較。結果參與調查的12傢醫院2011年新生兒科共收治患兒9994例,RDS患兒366例,佔新生兒收治總數的3.7%。常見的圍產期高危因素依次為：低Apgar評分23.5%,多胎20.5%,妊娠期高血壓17.8%,胎膜早破14.8%,胎盤早剝3.6%,妊娠期糖尿病2.2%。西安組的產前激素使用率(9.2%)低于地市組(10.0%),χ2=42.899,P <0.05；剖宮產率(71.1%)高于地市組(41.7%),χ2=37.843,P<0.05；西安組錶麵活性物質(PS)使用早(u=4.104,P<0.05)、INSURE技術及輔助通氣使用率高(χ2值分彆為9.206、6.461,均P<0.05)、輔助通氣時間短(u=1.965,P<0.05),地市組平均住院時間低于西安組(u=3.732,P<0.05)。常見併髮癥依次為：腦室內齣血10.7%、肺齣血3.4%、導管未閉3.2%、支氣管肺髮育不良2.4%、壞死性小腸結腸炎2.1%、腦室徬白質軟化2.1%、肺氣漏0.9%。 RDS患兒總病死率為8.2%(30/366)。結論陝西省RDS的救治應繼續規範產前糖皮質激素治療、降低剖宮產率預防RDS髮生,與省會城市相比其他地區PS使用仍不足,齣生後儘早、足量使用PS及INSURE技術是本省急需解決的問題。
목적：조사합서성신생인호흡군박종합정( RDS)적진치현상,탐토본지구RDS진료과정중적문제급대책。방법채용묘술성류행병학조사방법,회고성조사합서성내12가의원신생인병방우2011년1월1일지12월31일소유진단위RDS적환인,수집전부병례적기본정황、위산기、림상표현급치료、병발증급예후등정황。병차안의료궤구소재지분위이성회성시서안조급기타지시조진행비교。결과삼여조사적12가의원2011년신생인과공수치환인9994례,RDS환인366례,점신생인수치총수적3.7%。상견적위산기고위인소의차위：저Apgar평분23.5%,다태20.5%,임신기고혈압17.8%,태막조파14.8%,태반조박3.6%,임신기당뇨병2.2%。서안조적산전격소사용솔(9.2%)저우지시조(10.0%),χ2=42.899,P <0.05；부궁산솔(71.1%)고우지시조(41.7%),χ2=37.843,P<0.05；서안조표면활성물질(PS)사용조(u=4.104,P<0.05)、INSURE기술급보조통기사용솔고(χ2치분별위9.206、6.461,균P<0.05)、보조통기시간단(u=1.965,P<0.05),지시조평균주원시간저우서안조(u=3.732,P<0.05)。상견병발증의차위：뇌실내출혈10.7%、폐출혈3.4%、도관미폐3.2%、지기관폐발육불량2.4%、배사성소장결장염2.1%、뇌실방백질연화2.1%、폐기루0.9%。 RDS환인총병사솔위8.2%(30/366)。결론합서성RDS적구치응계속규범산전당피질격소치료、강저부궁산솔예방RDS발생,여성회성시상비기타지구PS사용잉불족,출생후진조、족량사용PS급INSURE기술시본성급수해결적문제。
Objective To investigate the diagnosis and treatment status of neonatal respiratory distress syndrome ( RDS) in Shaanxi Province and explore the problems and countermeasures for RDS diagnosis and treatment. Methods Data of infants with RDS in 12 hospitals participating in the study during the period of January 1 to December 31 in 2011 were investigated retrospectively with descriptive epidemiological survey, including basic situation, perinatal period, clinical manifestations, treatment, complications and prognosis. The patients were divided into Xi’ an group and other city group for comparison. Results Among 9 994 newborns admitted in 12 hospitals in 2011, 366 infants were diagnosed with RDS, accounting for 3. 7%. The common high risk factors in perinatal period were low Apgar score (23. 5%), multiple gestation (20. 5%), gestational hypertension (17. 8%), premature rupture of membrane (14. 8%), placental abruption (3.6%) and gestational diabetes mellitus (2.2%). The antenatal steroids use rate in Xi’an group (9.2%) was lower than that in other city group (10. 0%) (χ2 =42. 899,P<0. 05), but the cesarean section rate (71. 1%) was higher than that in other city group (41. 7%) (χ2 =37. 843,P <0. 05). Compared with other city group, PS was used earlier (u =4. 104,P <0. 05), INSURE technology and assisted ventilation were used more frequently (χ2 value was 9. 206 and 6. 461, respectively, both P<0. 05), and assisted ventilation was shorter (u=1. 965,P<0. 05) in Xi’ an group. The hospitalization length was longer in other city group than in Xi’ an group (u=3. 732,P <0. 05). Common complications were intraventricular hemorrhage (10. 7%), pulmonary hemorrhage (3. 4%), patent ductus (3. 2%), bronchopulmonary dysplasia (2. 4%), necrotizing enterocolitis (2. 1%), periventricular leukomalacia (2. 1%) and air leak (0. 9%). The total mortality of neonates with RDS was 8. 2% (30/366). Conclusion In Shaanxi Province further standardized prenatal GC treatment and reduction of cesarean section rate are needed for RDS diagnosis and treatment. Compared with Xi’ an, PS use is not sufficient in other cities. Early and sufficient use of PS and INSURE technology after birth are urgent issues in Shaanxi Province.
