新生儿呼吸窘迫综合征X线表现与临床分析

目的:探讨新生儿呼吸窘迫综合征(NRDS)的X线表现及临床特点,比较使用肺表面活性物质(PS)与机械通气的差异.方法:回顾分析2004年1月至2006年12月收治的32例新生儿NRDS临床特点、胸片表现和诊治经过.分析影像表现与临床特点的相关性.比较使用表面活性剂在减少肺部并发症等方面的差异.结果:本组32例患儿中,首次胸片Ⅰ级7例,Ⅱ级11例(病死1例),Ⅲ级8例(病死1例),Ⅳ级3例(病死1例),正常3例.本组患儿中低出生体质量患儿18例,极低出生体质量儿11例.本组中20例患儿接受表面活性剂替代治疗.NRDS患儿胸片表现具有特征性,胎龄及出生体质量与首次胸片等级分布有差异(P＜0.05).使用PS与仅使用nCPAP两者有差异(P＜0.01).结论:胎龄越小、出生体质量越轻,首次胸片等级表现越趋向于Ⅱ级以下.患儿尽早使用表面活性物质治疗后拔管迅速建立nCPAP是安全有效的,可以减少机械通气和对呼吸支持的需要.

X-ray findings and clinical analysis for newborn infants withneonatal respiratory distress syndrome

OBJECTIVE: To discuss X-ray findings and clinical analysis of neonatal respiratory distress syndrome (NRDS), and to compare the use of pulmonary surfactant and mechanical ventilation. METHODS: The X-ray findings, clinical characteristics, and therapy analysis of 32 babies with NRDS were studied retrospectively from Jan. 2004 to Dec. 2006. The correlation between X-ray findings and clinical characteristics was analyzed. The advantages of surfactant replacement therapy, compared with mechanical ventilation alone were discussed. RESULTS: According to X-ray findings all babies were divided into Stage I (n=7), Stage II (n=11), Stage III (n=8), Stage IV (n=3), and normal (n=3). Of them, 18 were very low-birth-weight neonates, and 11 were very low-birth-weight neonates. Twenty received surfactant replacement therapy, after the diagnosis of NRDS had been established clinically and radiographically. NRDS had classic chest radiographic findings. There was statistically significant difference between the fetal age or birth weight and the first time X-findings (P<0.05), and difference existed between the use of surfactant and nCPAP alone (P<0.01). CONCLUSION: The younger the fetal age and the lower the birth weight, the more likely that the first X-ray findings would be below Stage II. Early surfactant replacement therapy with extubation to nCPAP for infants with NRDS was not only safe and beneficial, but also it significantly reduced both the need for mechanical ventilation and the briefer requirement for respiratory supports.