出生24h内新生儿肺出血病因与死因分析

目的 探讨出生24h内新生儿肺出血的病因与死因,并推测其与胎儿肺出血的关系.方法 选择114例出生24h内即发生肺出血的新生儿,根据临床与病理资料进行分析.结果 114例患儿的肺部病理检查结果,点状肺出血6例,局灶性肺出血印例,弥漫性肺出血48例.28例于生后0～6h,71例于生后7～12h,15例于生后13～24h内发病.肺出血病因中缺氧因素110例,包括吸入性肺炎62例、呼吸窘迫综合征24例、青紫型复杂心脏畸形7例、肺膨胀不全7例、新生儿窒息7例、其他原因缺氧3例;感染因素4例,病因均为宫内感染所致败血症.肺出血患儿死亡因素中缺氧因素113例,包括肺出血74例、吸人性肺炎15例、呼吸窘迫综合征12例、青紫型复杂心脏畸形7例、肺膨胀不全2例、颅内出血2例、新生儿窒息1例;感染因素I例,为宫内感染所致败血症.82例有宫内窘迫史,在直接死于肺出血的74例中,3例有宫内窘迫史,且出生数分钟即死亡.结论 出生24 h内新生儿肺出血病因及死因均以缺氧因素为主,大多有宫内窘迫.其中3例弥漫性肺出血患儿于出生数分钟即死亡,从而推测出生24h内新生儿肺出血,有相当部分可能为胎儿肺出血的延续.

Pathogenesis and death cause of neonatal pulmonary hemorrhage within postnatal 24h

Objective To investigate the pathogenesis and death cause of neonatal pulmonary hem orrhage (NPH) within postnatal 24 h and speculate their relation to fetal pulmonary hemorrhage. Methods To select the 114 cases of NPH within postnatal 24 h confirmed by pathological examination. According to the pathologic and clinic diagnosis materials, the pathogenesis and death cause of NPH within postnatal 24 h and their relation to fetal pulmonary hemorrhage were analyzed. Results Of the 114 cases with NPH,there were 6 cases of petechial pulmonary hemorrhage,60 cases of focal pulmonary hemorrhage and 48 cases of diffuse pulmonary hemorrhage. The discovery time of NPH were 28 cases at 0～6 h ,71 cases at 7～12 h and 15 cases at 13～24 h after birth. The pathogenesis in 114 cases of NPH could be divided into identical 2 major factors: 110 cases of the oxygen deficient factor consisting of amniotic fluid aspiration pneumonia( 62 cases) .hyaline membrane disease(24 cases) .complexity cyanotic congenital heart disease(7 cases),congenital pulmonary a-genesis(7 cases),neonatal asphyxia (7 cases),intracranial hemorrhage(2 cases) and hypoxic ischemic en-cephalopathy(1 cases) .respectively. Four cases were due to infection including sepsis which was caused by intrauterine infection. The death causes in 114 cases of NPH included hypoxia (113 cases) which consisted of pulmonary hemorrhage (74 cases) .amniotic fluid aspiration pneumonia(15 cases) .hyaline membrane dis-ease(12 cases),complexity cyanotic congenital heart disease(7 cases),congenital pulmonary agenesis(2 ca-ses) ,intracranial hemorrhage(2 cases) .neonatal asphyxia (1 cases) .and infectious factor(1 case) of sepsis which was caused by intrauterine infection. In 114 cases,82 cases had fetal distress,74 cases died from NPH directly including 3 cases with fetal distress died within a few minutes after birth. Conclusion Oxygen defi-cient is an important factor in pathogenesis and death cause of NPH within postnatal 24 h. The majority of ca-ses have the fetal distress and died from NPH directly in short time. Because of 3 cases NPH died within a few minutes after birth, therefore we conjecture that the most cases of NPH within postnatal 24 h may be a ex-tension of fetal pulmonary hemorrhage.