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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9 994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%),x~2=42.899,P<0.05;剖宫产率(71.1%)高于地市组(41.7%),x~2=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(x~2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。
Objective To investigate the diagnosis and treatment of neonatal respiratory distress syndrome (RDS) in Shaanxi Province and to explore the problems and countermeasures in the RDS diagnosis and treatment in this area. Methods Descriptive epidemiological survey method was used to retrospectively survey all neonates with RDS diagnosed in neonatal ward of 12 hospitals in Shaanxi Province from January 1 to December 31, 2011. The basic situation of all cases was collected. Delivery, clinical manifestations and treatment, complications and prognosis. And according to the location of medical institutions is divided into the capital city of Xi’an and other city groups for comparison. Results In the 12 hospitals participating in the survey, 9,994 children were admitted to the neonatology department in 2011, and 366 children with RDS accounted for 3.7% of the total number of newborns admitted. Common risk factors for perinatal were: low Apgar score 23.5%, multiple births 20.5%, gestational hypertension 17.8%, premature rupture of membranes 14.8%, placental abruption 3.6%, gestational diabetes 2.2%. The prenatal hormone utilization rate in Xi’an group (9.2%) was lower than that in city group (10.0%), x ~ 2 = 42.899, P <0.05; cesarean section rate was 71.1% x 2 = 37.843, P <0.05; the use of surface active substance (PS) in Xi’an group was earlier (u = 4.104, P <0.05); INSURE technique and assisted ventilation were higher (x ~ 2 values were 9.206,6.461, P <0.05). The time of assisted ventilation was shorter (u = 1.965, P <0.05). The average hospital stay in Xi’an was lower than that in Xi’an (u = 3.732, P <0.05). Common complications were as follows: 10.7% of intraventricular hemorrhage, 3.4% of pulmonary hemorrhage, 3.2% of patent ductus, 2.4% of bronchopulmonary dysplasia, 2.1% of necrotizing enterocolitis, 2.1% of ventricular white matter softening and 0.9% of pulmonary air leakage. The overall case fatality rate in children with RDS was 8.2% (30/366). Conclusion The treatment of RDS in Shaanxi Province should continue to regulate antenatal glucocorticoid therapy and reduce the rate of cesarean section to prevent the occurrence of RDS. Compared with the capital cities, the PS use in other areas is still insufficient. As soon as possible after birth, adequate use of PS and INSURE technology is the province Urgent problems.