足月新生儿呼吸窘迫综合征危险因素及肺表面活性物质疗效评估

目的探讨足月新生儿呼吸窘迫综合征（RDS）的危险因素，观察肺表面活性物质（PS）的疗效，为足月儿RDS的防治提供依据。方法选取2007年1月至2011年12月郑州大学第三附属医院NICU收治的足月儿RDS为RDS组，以同期入院的非RDS足月儿为对照组，对两组性别、胎龄、分娩方式、宫内窘迫、出生窒息、母亲妊高症、糖尿病、胎膜早破进行单因素方差分析和Logistic多因素回归分析；并以RDS组中是否给予PS治疗分为应用PS亚组和未应用PS亚组，评估PS的疗效。结果RDS组和对照组各106例进入分析。 ①RDS组发病时间为生后5 min至18 h，平均（4.9±3.4）h，其中生后6 h内发病87例（82.1%），~12 h 16例（15.1%），>12 h 3例（2.8%）；X线胸片分级Ⅰ级28例（26.4%），Ⅱ级36例（34.0%），Ⅲ级23例（21.7%），Ⅳ级19例（17.9%）；②Logistic回归分析显示男性(OR=10.35, 95%CI:1.94~15.26)、胎龄<39周(OR=6.59,95%CI:2.33~36.51)、剖宫产(OR=7.26,95%CI:11.61~23.22)、择期剖宫产(OR=13.14,95%CI:3.55~21.84)和出生窒息(OR=4.33,95%CI: 2.74~27.39)是足月儿RDS的危险因素；③应用PS亚组72例，未应用PS亚组34例。机械通气发生率、机械通气天数、氧疗时间、住院天数和呼吸机相关性肺炎发生率应用PS亚组均显著低于未应用PS亚组（P<0.05）；两亚组气胸、肺出血、持续性肺动脉高压和动脉导管未闭发生率差异均无统计学意义（P>0.05）。结论男性、胎龄<39周、剖宫产尤其是无医学指征的择期剖宫产、出生窒息是足月儿RDS的危险因素，PS治疗足月儿RDS疗效较好。

Risk factors of respiratory distress syndrome in full-term newborns and the efficacy of pulmonary surfactant

ObjectiveTo discuss the risk factors and clinical characteristics of respiratory distress syndrome (RDS) in full-term newborns. Methods Retrospective analysis was conducted among full-term infants with RDS from January 2007 to December 2011, and was compared with the hospitalized full-term newborns without RDS in the same period. The risk factors were studied such as asphyxia, maternal gestational hypertension, diabetes, premature rupture of membranes and were compared between the two groups and one-way ANOVA and multivariate logistic regression were performed. The clinical outcome and complications were also compared between patients using pulmonary surfactant(PS) or not. Results①82.1% (87 cases) of RDS in full-term infants occurred within 6 h after birth, 15.1%(16 cases) occurred within 6-12 h after birth, 2.8%(3 cases) occurred after 12 h after birth, no case occurred after 24 h after birth. The X-ray grades of Ⅰ,Ⅱ,Ⅲ,Ⅳ were in 28 cases（26.4%），36 cases（34.0%），23 cases（21.7%），and 19 cases（17.9%）, respectively. ② In the respects of male, gestational age less than 39 weeks, cesarean section, especially elective cesarean section without medical indications, birth asphyxia, the ratios of RDS group were higher than control group(P<0.05). Logistic regression analysis further suggested that the factors mentioned above were related to full-term newborns with RDS(P<0.05). ③The use of PS reduced the chances of mechanical ventilation, shortened the days of mechanical ventilation, duration of oxygen therapy and hospitalization days, and reduced the incidence of ventilator-associated pneumonia(VAP) (P<0.05) in the RDS group. Compared with the group without use of PS, there was no significant difference between the two groups in the incidence of pneumothorax, pulmonary hemorrhage, persistent pulmonary hypertension of newborn, patent ductus arteriosus did not significantly differ (P>0.05). ConclusionsMale,gestational age less than 39 weeks, cesarean section, especially elective cesarean section without medical indications and neonatal asphyxia are risk factors of RDS in full-term newborns.The using of PS has positive effect on reducing mechanical ventilation chance, delay-on time of mechanical ventilation, the number of days with mechanical ventilation and oxygen therapy days, VAP incidence and hospitalization time of RDS in full-term newborns.