Chen Ying-Yao, Wang Hsiao-Ping, Lin Shu-Ming, Chang Jenn-Tzong, Hsieh Kai-Sheng, Huang Fu-Kuei, Chiou Yee-Hsuan, Huang Yung-Feng
Division of Neonatology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Pediatr Int. 2012 Dec;54(6):743-7. doi: 10.1111/j.1442-200X.2012.03670.x. Epub 2012 Sep 11.
Beginning 2007, the intratracheal route of epinephrine to end massive pulmonary hemorrhage (MPH) in very low-birthweight (VLBW) infants was modified at Kaohsiung Veterans General Hospital. The aim of the present study was to assess the change in outcomes for these infants, and to evaluate the risk factors of MPH.
Using the database of the Premature Baby Foundation of Taiwan, the mortality, risk factors and characteristics of VLBW infants with or without MPH were compared between 2000-2006 and 2007-2010.
Between January 2000 and December 2010, 399 VLBW infants were admitted to Kaohsiung Veterans General Hospital. Mean birthweight (BW) was 1099.6 ± 272.7 g, and mean gestational age (GA) was 28.7 ± 2.9 weeks. The overall survival rate was 84.2%. Sixteen (4%) had MPH: 11 in the first group (2000-2006; 18.2% survival rate), and five in the second group (2007-2010; 80% survival rate; P= 0.0000002). Infants with MPH had lower mean BW (864.9 ± 301.4 g, P= 0.0004), smaller mean GA (26.1 ± 2.0 weeks, P= 0.0002), significantly lower Apgar scores at 1 and 5 min, higher severity of respiratory distress syndrome (RDS; grades 3 or 4), and greater use of surfactant than infants without MPH. They also had more intraventricular hemorrhage and higher mortality.
Smaller GA, lower BW, lower Apgar scores at 1 and 5 min, severe RDS (grades 3 or 4), and use of surfactant place VLBW infants at greater risk of MPH. Proper prenatal care and preventing premature labor and delivery were the most important preventative factors. A quick, deep thrust of intratracheal epinephrine with a catheter may improve survival.
自2007年起，高雄荣民总医院对极低出生体重（VLBW）婴儿采用气管内途径给予肾上腺素以终止大量肺出血（MPH）的方法进行了改进。本研究的目的是评估这些婴儿的预后变化，并评估MPH的危险因素。
利用台湾早产儿基金会的数据库，比较了2000 - 2006年和2007 - 2010年有或无MPH的VLBW婴儿的死亡率、危险因素和特征。
2000年1月至2010年12月期间，399例VLBW婴儿入住高雄荣民总医院。平均出生体重（BW）为1099.6±272.7克，平均胎龄（GA）为28.7±2.9周。总体生存率为84.2%。16例（4%）发生MPH：第一组11例（2000 - 2006年；生存率18.2%），第二组5例（2007 - 2010年；生存率80%；P = 0.0000002）。发生MPH的婴儿平均BW较低（864.9±301.4克，P = 0.0004），平均GA较小（26.1±2.0周，P = 0.0002），1分钟和5分钟时阿氏评分显著较低，呼吸窘迫综合征（RDS）严重程度较高（3级或4级），使用表面活性剂的比例高于未发生MPH的婴儿。他们还发生更多的脑室内出血且死亡率更高。
GA较小、BW较低、1分钟和5分钟时阿氏评分较低、严重RDS（3级或4级）以及使用表面活性剂使VLBW婴儿发生MPH的风险更高。适当的产前护理以及预防早产和分娩是最重要的预防因素。用导管快速、深入地推注气管内肾上腺素可能会提高生存率。
