32例晚期早产儿和足月儿呼吸窘迫综合征临床分析

目的了解晚期早产儿和足月儿呼吸窘迫综合征(respiratory distress syndrome,RDS)的临床特征,提高对该病的认识。方法将皖北煤电集团总医院新生儿病房2004年1月-2011年9月收治的32例胎龄≥34周的晚期早产儿或足月儿RDS为研究对象,即晚期早产儿-足月儿组;同期收治的胎龄<34周早产儿RDS 36例为对照组,即早产儿组。对两组患儿的病因、临床表现、治疗措施和并发症等资料进行对比分析。结果①两组发生RDS的病因不同:早产儿以早产为主要病因,晚期早产儿或足月儿以选择性剖宫产、围生期窒息、胎粪吸入等为主要原因。②晚期早产儿和足月儿发生RDS应用呼吸机时间较晚,应用常规剂量外源性肺表面活性物质(PS)24 h后氧和指数(OI)较早产儿高(P<0.05)。结论晚期早产儿-足月儿RDS病因以产程未发动的择期剖宫产和围生期窒息为主,开始应用呼吸机治疗的时间晚,且应用外源性PS效果不如早产儿好。晚期早产儿或足月儿RDS易并发新生儿持续肺动脉高压(PPHN)、气漏综合征和多脏器功能衰竭等并发症。

Clinical Analysis of 32 Late Preterm and Mature Infants with Respiratory Distress Syndrome

Objective To investigate the clinical characteristics of respiratory distress syndrome(RDS) in mature and late-preterm infants.Methods The RDS neonates from January 2004 to September 2011 in our hospital were collected.32 mature and late-preterm infants with the gestational age more than 34 weeks were included in the experimental group,while 36 premature infants with the gestational age less than 34 weeks were attributed to the control group.The cause of disease,clinical manifestation,therapeutic measures and complications were analyzed and compared between the two groups.Results ①The main causes of disease were the premature delivery in the control group,but were the selective caesarean section,perinatal asphyxia and meconium aspiration in the experimental group.②The application of mechanical ventilation(MV) was later in the experimental group,and the OI was higher 24 h after using the convention dosage of exogenous pulmonary surfactant(P<0.05).Conclusion The main cause of RDS in mature and late-preterm infants were the selective caesarean section and perinatal asphyxia,the need for the mechanical ventilation is later,and the curative effect of exogenous pulmonary surfactant is not as good as the premature infants.The persistent pulmonary hypertension of the newborn(PPHN),pneumothorax and multiple organ dysfunction syndrome are the common complications.