足月新生儿呼吸窘迫综合征的临床特征、诊断和治疗。

Clinical characteristics, diagnosis and management of respiratory distress syndrome in full-term neonates.

机构信息

Department of Neonatology & NICU, Bayi Children's Hospital Affiliated to General Hospital of Beijing Military Command, Beijing 100700, China.

出版信息

Chin Med J (Engl). 2010 Oct;123(19):2640-4.

PMID:21034645

Abstract

BACKGROUND

Respiratory distress syndrome (RDS) is one of the most common causes of neonatal respiratory failure and neonatal death, however, its clinical characteristics are very different from premature RDS, and these characteristics have not been well documented as yet. This study was to investigate the pathogenesis, clinical characteristics and management strategies of RDS in full-term neonates, with the aim of developing a working protocol for improving the outcome in full-term neonates with RDS.

METHODS

A total of 125 full-term infants with RDS were enrolled in this study. Their clinical and laboratory data were collected for analyzing the characteristics of full-term neonatal RDS.

RESULTS

(1) The 125 cases included 94 male and 31 female infants, vaginal delivery occurred in 80 cases and cesarean section in 45 cases. (2) The onset time of RDS was (3.11 ± 3.59) hours after birth. (3) The possible reasons included severe perinatal infections in 63 patients, elective cesarean section in 34 cases, severe birth asphyxia in 12 patients, meconium aspiration syndrome in 9 patients, pulmonary hemorrhage in 4 patients and maternal diabetes in 3 patients. (4) Complications included multiple organ system failure (MOSF) in 49 patients, persistent pulmonary hypertension of newborn (PPHN) in 25 patients, acute renal failure in 18 patients, severe hyperkalemia in 25 patients, severe metabolic acidosis in 6 cases, severe myocardial injury in 9 cases, pulmonary hemorrhage in 3 cases, disseminated intravascular coagulation in 14 patients and shock in 12 patients. (5) Four patients died, the mortality was therefore 3.2% with the main cause of septicemia complicating of MOSF, but their prognosis was improved while comprehensive treatment measures including early mechanical ventilation and broad spectrum antibiotics were taken into account.

CONCLUSIONS

RDS is not an uncommon disease in full-term infants and is associated with a higher mortality, its clinical characteristics are very different from premature RDS, and its onset is earlier and is more likely to develop into PPHN and/or MOSF. The main cause of death is severe infection complicating of MOSF and most patients require prolonged mechanical ventilation. Comprehensive management strategies will help to improve patient's prognosis.

摘要

背景

呼吸窘迫综合征（RDS）是新生儿呼吸衰竭和新生儿死亡的最常见原因之一，然而，其临床特征与早产儿 RDS 非常不同，这些特征尚未得到很好的记录。本研究旨在探讨足月新生儿 RDS 的发病机制、临床特征和治疗策略，以期制定改善足月新生儿 RDS 预后的工作方案。

方法

共纳入 125 例足月 RDS 患儿，收集其临床和实验室资料，分析足月新生儿 RDS 的临床特征。

结果

（1）125 例患儿中男 94 例，女 31 例，阴道分娩 80 例，剖宫产 45 例。（2）RDS 发病时间为出生后（3.11±3.59）h。（3）可能病因：围生期严重感染 63 例，选择性剖宫产 34 例，重度窒息 12 例，胎粪吸入综合征 9 例，肺出血 4 例，母亲糖尿病 3 例。（4）并发症：多器官功能障碍综合征（MOSF）49 例，新生儿持续性肺动脉高压（PPHN）25 例，急性肾衰竭 18 例，严重高钾血症 25 例，严重代谢性酸中毒 6 例，严重心肌损伤 9 例，肺出血 3 例，弥漫性血管内凝血（DIC）14 例，休克 12 例。（5）死亡 4 例，病死率 3.2%，主要死亡原因为败血症合并 MOSF，但经积极抗感染、机械通气等综合治疗后病情好转。