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目的回顾性分析新生儿病房1998-2012年来诊断为新生儿呼吸窘迫综合征(respiratory distress syndrome,RDS)的早产儿病例,总结在治疗措施方面的进展。方法回顾性病例对照研究,1998年1月-2012年12月本院新生儿重症监护病房(NICU)收治的<34周新生儿呼吸窘迫综合征早产儿病例,记录母孕期情况和围产期情况,出生史和采用呼吸支持方式(有创或无创呼吸支持),是否应用肺表面活性物质(pulmonary surfactant,PS),用药剂量以及患儿的合并症和结局。结果自1998年1月-2004年12月为A组,63例;2005年1月-2012年12月病例为B组,151例。B组患儿出生体重[(1 284.50±252.15)g]明显低于A组[(1 424.27±329.44)g](t=3.292,P<0.001),分娩前应用激素促进肺成熟的病例数明显增加(B组139例,92.1%;A组44例,69.8%;χ2=17.704,P<0.001);B组应用PS总量为(195.00±59.87)mg,A组中应用PS总量为(169.66±57.97)mg,两组间差异有统计学意义(P=0.041);计算PS与体重比值,B组为(147.71±42.09)mg/kg,A组为(115.86±37.11)mg/kg,差异显著(P<0.01)。B组85(70.8%)应用有创呼吸支持,较A组39例(90.7%),显著降低(χ2=6.86,P<0.01)。B组33例(27.5%)诊断支气管肺发育不良(BPD),较A组4例(9.3%)显著增高(χ2=5.97,P=0.02)。住院天数、NICU住院天数、氧疗天数都是B组显著长于A组。A组12例死亡,病死率27.9%,而B组14例死亡,病死率11.7%,两组比较差异有统计学意义(χ2=6.23,P=0.01)。结论在过去十余年来,随着分娩前应用激素促肺成熟及外源性表面活性物质的引入,采用适宜的呼吸支持方式,使越来越多的RDS早产儿得以存活。
Objective To retrospectively analyze the cases of premature infants diagnosed as neonatal respiratory distress syndrome (RDS) in neonatal ward from 1998 to 2012 and summarize the progress in the treatment measures. Methods Retrospective case-control study, January 1998 - December 2012 hospital neonatal intensive care unit (NICU) admitted to the <34 weeks of neonatal respiratory distress syndrome cases of premature children, records during pregnancy and perinatal conditions , Birth history and the use of respiratory support (invasive or noninvasive respiratory support), the use of pulmonary surfactant (PS), dosage, and comorbidities and outcomes in children. Results From January 1998 to December 2004 for group A, 63 cases; January 2005-December 2012 cases for group B, 151 cases. The birth weight in group B was significantly lower than that in group A ([(424.27 ± 329.44) g] (t = 3.292, P <0.001) (Group B, 139 cases, 92.1%; group A, 44 cases, 69.8%; χ2 = 17.704, P <0.001). The total amount of PS in group B was (195.00 ± 59.87) 169.66 ± 57.97) mg, the difference between the two groups was statistically significant (P = 0.041); the ratio of PS to body weight was calculated. The B group was (147.71 ± 42.09) mg / kg and the A group was (115.86 ± 37.11) mg / The difference was significant (P <0.01). In group B, 85 (70.8%) patients had invasive respiratory support, which was significantly lower than that in 39 patients (90.7%) in group A (χ2 = 6.86, P <0.01). B group 33 cases (27.5%) diagnosed bronchopulmonary dysplasia (BPD), compared with 4 cases in group A (9.3%) was significantly higher (χ2 = 5.97, P = 0.02). Hospitalization days, NICU days of hospitalization, oxygen therapy days were significantly longer in group B than in group A. In group A, 12 patients died and the case fatality rate was 27.9%. In group B, 14 patients died and the case fatality rate was 11.7%. There was significant difference between the two groups (χ2 = 6.23, P = 0.01). CONCLUSIONS In the past decade or more, with the introduction of hormones to promote lung maturation and the introduction of exogenous surfactant before delivery, more and more RDS preterm infants were survived with appropriate respiratory support.