分娩方式对足月新生儿急性呼吸窘迫综合征的影响

目的探讨分娩方式及其他相关因素对足月新生儿发生急性呼吸窘迫综合征（ARDS）的影响。方法选取73 665例足月新生儿，根据娩出方式分为阴道分娩组34 688例、择期剖宫产组26 781例和非择期剖宫产组12 196例，比较3组新生儿的ARDS发生率；并随机选取其中420名健康足月儿为对照组，102例ARDS患儿为病例组，采用多因素logistic回归分析ARDS的危险因素。结果择期剖宫产组ARDS发生率为0.26%，均明显高于阴道分娩组（0.04%）和非择期剖宫产组（0.13%）（P < 0.01）。logistic回归分析结果显示，男婴、新生儿窒息史、胎盘异常史、羊水吸入史、母亲妊娠期高血压和妊娠期糖尿病均为新生足月儿发生ARDS的独立危险因素（P < 0.01）。结论产妇在选择分娩方式时应尽量选择自然阴道分娩或非择期剖宫产，对于有相关危险因素的产妇，应及早干预以降低新生儿ARDS发生率。

Effect of the delivery mode on the acute respiratory distress syndrome in full-term neonates

ObjectiveTo investigate the effects of delivery mode and other related factors on acute respiratory distress syndrome(ARDS) in full-term neonates.MethodsA total of 73 665 full-term neonates were divided into the vaginal delivery group(34688 cases), elective cesarean group(26781 cases) and nonelective cesarean group(12196 cases).The incidence rate of ARDS was compared among three groups.Four hundred and twenty healthy full-term neonates and 102 ARDS neonates were randomly selected, and divided into the control group and case group, respectively.The risk factors of ARDS were analyzed using logistic regression analysis.ResultsThe incidence rate of ARDS in elective cesarean group(0.26%) was significantly higher than that in vaginal delivery group (0.04%) and nonelective cesarean group (0.13%)(P < 0.01).The results of logistic regression analysis showed that the male, asphyxia, placenta, disfunctional placenta, aminotic fluid aspiration, intrauterine distress, maternal hypertension and maternal diabetes were the independent risk factors of ARDS in full-term neonates(P < 0.01).ConclusionsThe gravidas should choose the natural vaginal delivery or nonelective cesarean as far as possible, the obstetricians should pay more attention to gravidas with risk factors, and the early intervention can reduce the incidence rate of ARDS in full-term neonates.