新生儿急性呼吸窘迫综合征的病因与疗效观察

目的 分析足月新生儿急性呼吸窘迫综合征的发病原因,探索其治疗的方法,分析肺表面活性剂的作用.方法 将所有的足月新生儿急性呼吸窘迫综合征患儿62例分成A(50例)、B组(12例)2组,B组在A组的治疗途径上另加肺表面活性物质进行治疗,并对2组各指标进行分析比较.分析指标包括:pH、PaO2、PaCO2、SaO2、HCO3.结果 新生儿窒息42例(68%);窒息合并吸入性肺炎36例(58%),剖宫产19例(31%),奶汁吸入性肺炎6例(10%),感染性肺炎3例(5%),ROC曲线显示曲线下面积分别为0.80、0.76、0.35、0.83、0.74,新生儿窒息,窒息合并吸入性肺炎,奶汁吸入性肺炎以及感染性肺炎和足月新生儿急性呼吸窘迫综合征具有相关性.A、B组的PaO2分别为(78.80±8.23)mm Hg和(87.20 ±8.30)mm Hg(t=4.56,P<0.05);SaO2分别为(89.50±5.40)%和(99.63±3.30)%(t=5.78,P<0.05);差异均有统计学意义.B组的治愈率为92%,A组的治愈率为80%(x2=3.5,P<0.05).结论 足月新生儿出现急性呼吸窘迫综合征的原因很多,指征宜放宽,并以临床严密观察和连续监测血氧饱和度为依据是行之有效的方法.肺表面活性剂对于治疗足月新生儿急性呼吸窘迫综合征疗效较好.

Study of cause and treatment efficiency of acute respiratory distress syndrome in full-term newborns

Objective To explore the pathogenesis of acute respiratory distress syndrome (ARDS) in fullterm newborns, and to assess the effect of pulmonary surfactant. Methods All full-term newboms were divided into two groups,with 50 cases in group A and 12 cases in group B. Compared to the treatment of group A,pulmonary surfactant was added to group B. The indicators of pH, PaO2, PaCO2, SaO2, HCO3- were compared between the two groups.Results The cure rate was 92% in group B , which was significant higher than that of 80% in group A( t = 3. 5,P < 0. 05 ). There were 42 cases of neonatal asphyxia (68%), 36 cases of asphyxia combined aspiration pneumonia (58% ) ,19 cases of cesarean section(31% ) ,6 cases of milk aspiration pneumonia (10% ) and 3 cases of infectious pneumonia (5 % ). The AUC was 0. 80,0. 76,0. 35,0. 83 and 0.74, respectively.Neonatal asphyxia, asphyxia combined aspiration pneumonia,milk aspiration pneumonia and infectious pneumonia were associated with ARDS in full-term newborns. PaO2 in group A and B was (78. 80 ± 8. 2 ) mm Hg and (87. 20 ± 8. 30) mm Hg, respectively (t = 4. 56, P < 0. 05 ). SaO2 in group A was (89. 50 ± 5.40) % ,which was significantly lower than that of (99. 63 ± 3. 30 ) % in group B (t = 5. 78, P < 0. 05). Conclusions There are various causes of ARDS in full-term newborns.Intensive clinical observation and continuous monitoring of blood oxygen saturation will be helpful to improve the efficiency of treatment Pulmonary surfactants can improve the efficiency in the treatment of ARDS in the full-term newboms.