早期 晚期早产儿与足月新生儿 呼吸窘迫综合征临床比较分析

目的　 探讨早期、晚期早产儿与足月儿呼吸窘迫综合征（RDS）的发病趋势和临床特征的差异，为临床合理诊治提供依据。方法　2006年1月至2010年12月在郑州大学第三附属医院住院的963例RDS患儿根据胎龄不同分为早期早产儿组（ < 34周）679例，晚期早产儿组（34～ < 37周）204例，足月儿组（≥37周）80例，分别对各组患儿的发病率、入院情况、高危因素、临床诊治、预后及并发症进行比较。结果　RDS的发病率逐年增加，均以早期早产儿占多数，晚期早产儿和足月儿RDS比例有增多趋势；RDS患儿男婴超过女婴（P < 0.05），且胎龄和体重越大，男婴比例越高；足月儿RDS组产前糖皮质激素使用率明显低于早产儿组；早产儿发生RDS的高危因素主要有胎膜早破、胎盘异常、母亲妊娠高血压疾病，足月儿发生RDS的高危因素主要是择期剖宫产与感染；晚期早产儿与足月儿RDS的临床诊断和应用肺泡表面活性物质（PS）时间均晚于早期早产儿；足月儿RDS应用机械通气比例明显高于早产儿，其临床治愈率高（P < 0.05），在死亡率方面与早产儿组无差别；但并发气胸的比例高于早产儿组（P < 0.05）。结论　新生儿呼吸窘迫综合征（NRDS）发病率逐年增高，晚期早产儿和足月儿RDS比例有增多趋势；早期、晚期早产儿与足月儿RDS在性别比例、高危因素、起病特点、治疗反应与并发症方面均存在差异，RDS的诊治需要考虑胎龄因素。足月儿RDS多与择期剖宫产、感染有关，发病相对较晚，容易合并气胸，应引起足够重视。

Clinical features of early preterm infants，late preterm infants and full term infants with respiratory distress syndrome.

Abstract： Objective　To investigate the different clinical characteristics of neonatal RDS with various gestational ages and to provide a new basis for clinical therapy. Methods　A total of 963 cases of RDS infants in the Third Affiliated Hospital of Zhengzhou University from Jan.2006 to Dec.2010 were divided into early preterm infants group （ < 34 weeks，679 cases），late preterm group （34 ～ < 37 weeks，204 cases），and full-term group （≥ 37 weeks，80 cases） according to gestational age respectively，and the general situation，risk factors，clinical condition，prognosis and complications in each group were analyzed. Results　There was an increasing tendency for the incidence of RDS，which predominantly happened in the early preterm infants. What’s more，the prevalence of RDS in late preterm infants and term infants was increased. The proportion of RDS in the male was higher than the female （P < 0.05），especially when the gestational ages and weight were greater. The antenatal use of glucocorticoid in full-term RDS infants was significantly lower than the preterm infants. The risk factors of preterm RDS were closely relevant to the rupture of membranes，placental abnormalities，women with pregnancy-induced hypertension，while those of the full-term newborns with RDS were frequently related to selective cesarean section. The time window of the diagnosis of the full-term RDS was later than that of the preterm RDS. The application of mechanical ventilation to full-term RDS infants was significantly more than to the preterm infants while the clinical cure rate was significantly higher（P < 0.05），but the mortality rate was not different，and more pulmonary infection and pneumothorax occured in full-term group consequently. Conclusion　The incidence of neonatal RDS is increasing yearly and the prevalence of RDS in late preterm infants and term infants increase. The different clinical characteristics between the preterm RDS and full-term RDS lie in the morbidity，sex ratio，risk factors，clinical characteristics，treatment response and complications etc. The gestational age factor should be considered to diagnose and treat RDS. The full-term RDS which are characterized by relatively late onset and complication of pneumothorax，has a close relation to elective cesarean section and infection，should be paid more attention to in the future.