新生儿肺出血高危因素及早期诊断的临床分析

目的:探讨新生儿肺出血的危险因素和早期诊断方法。方法:回顾性研究新生儿肺出血56例,分析高危因素及早期诊断方法。结果:56例肺出血的新生儿,早产、低体重、男婴发生率分别为58.93%、71.43%、76.79%,是生理性高危因素;原发病中重度窒息、感染、肺透明膜病、硬肿症、胎粪吸入综合征、肺动脉高压、先天性心脏病、胆红素脑病发生率分别为30.36%、19.64%、14.29%、12.5%、8.93%、7.14%、3.57%、3.57%,是病理性高危因素。肺出血前30 m in~4 h其临床症状和体征均有明显改变。有肺部湿罗音与无肺部湿罗音高危因素比较无显著性差异,但在死亡数及出现肺出血至死亡时间比较有显著性差异(P<0.05)。提示具有相同的危险因素,无肺部湿罗音进展及死亡均更快。气管插管行气管内吸引与口鼻涌血诊断肺出血在肺出血时间、死亡数、治愈数比较有显著性差异(P<0.05),气管内吸引更能早期发现,避免误诊,有助于及时治疗。结论:有严重原发病的高危新生儿出现紫绀苍白加重、呼吸心率改变、肺部湿罗音出现或增多、气管插管吸出血性痰可早期诊断肺出血,早期诊断是提高治疗效果的关鍵。

The clinical analysis of risk factors and early diagnosis of pulmonary hemorrhage of newborn infants.

Objective:To study the risk factors and early diagnosis of pulmonary hemorrhage of newborn infants.Methods:Fifty-six newborn infants with pulmonary hemorrhage were retrospectively analyzed.Results:56 cases pulmonary hemorrhage of newborn infants,the incidences of premature infant,low birth weight,male infants were 58.93%,71.43%,76.79%,these were physiological risk factors.The incidences of asphyxia,infection,neonatal respiratory sydndrome,neonatal scleredema,meconium,aspiration syndrome,persistent pulmonary hypertension,congenital heart disease,kernicterus were 30.36%,19.64%,14.29%,12.5%,8.93%,7.14%,3.57%,3.57%,these were pathologic risk factors.The clinical symptom and sign significantly changed within 30 minutes to 4 hours before pulmonary hemorrhage.Risk factors were not significantly different in moist rale or no,but dead number and time were significantly different(P<0.05).It was significantly different in number of die and cure between suction hemic phlegm from intubation and mouth or nose bleed(P<0.05).Pulmonary hemorrhage can be earlier diagnosised by suction from intubation.Conclusion:Early pulmonary hemorrhage should be considered when newborn infants with serious disease suffer from cyanosis more serious,respiration and heart rate change,moist rale appear or more,suction hemic phlegm from intubation.Early diagnosis is the key factor to improve prognosis.