持续性肺动脉高压新生儿的危险因素和死亡率。
Risk factors and mortality among newborns with persistent pulmonary hypertension.
机构信息
Dr. Athar Razzaq,MBBS, FCPS, Trainee Fellow in Neonatal Pediatrics, The Children Hospital &Institute of Child Health, Multan, Pakistan.
Dr. Ahmed Iqbal Quddusi,MBBS, FCPS, Head of Neonatal Pediatrics, Warden's House, Rafia Hall, Girls Hostel, Nishter Medical College, Multan, Pakistan.
出版信息
Pak J Med Sci. 2013 Sep;29(5):1099-104. doi: 10.12669/pjms.295.3728.
OBJECTIVE
To determine the risk factors for persistent pulmonary hypertension of newborns (PPHN) and their influence on mortality.
METHODS
This was an observational study conducted at The Children's Hospital & the Institute of Child Health, Multan, Pakistan, from July 2011 to June 2012.All admitted babies who had respiratory distress, cyanosis and evidence of hypoxia on ABG,s were diagnosed provided that they were having right- to- left or bidirectional hemodynamic shunting at the ductus arteriosus or at patent foramen ovale along with Tricuspid regurgitation (TR) jet >40 mm of Hg on echocardiography. All the demographic, maternal, antenatal, natal and postnatal data were recorded on a predesigned Performa.
RESULTS
There were 79 patients, including 61 males and 18 females. The most common risk factors observed in our study were male sex (72.1%), cesarean section mode of delivery (54.2%), positive pressure ventilation while resuscitation (44.2%) birth asphyxia (40.4%) and meconium aspiration syndrome (MAS)35.4%. It was found that male sex (88.8%), cesarean-section delivery (77.7%), respiratory distress syndrome (RDS) 44.8% and sepsis (44.4%) were more associated with PPHN in premature infants than with term and post term infants. Out of the total 79 patients, death occurred among 7 preterm and 14 terms and post term infants. As a whole, cesarean section mode of delivery (71.4%), birth asphyxia (57.1%) and female sex (52.4%) were found major risk factors associated with mortality. However, respiratory distress syndrome (Relative Risk RR=5), birth asphyxia (RR=2.5) and male sex (RR=2)were found to be associated with increased risk of mortality in preterm than term and post term infants.
CONCLUSION
Male gender, cesarean section mode of delivery, MAS and RDS are the major risk factors for PPHN in any age group. RDS, Birth asphyxia and male sex are associated with increased risk of mortality in pre term than term and post term infants.
目的
确定新生儿持续性肺动脉高压（PPHN）的危险因素及其对死亡率的影响。
方法
这是一项在巴基斯坦木尔坦的儿童医院和儿童健康研究所进行的观察性研究。2011 年 7 月至 2012 年 6 月期间，所有因呼吸窘迫、发绀和 ABG 提示缺氧而入院的婴儿，只要其在动脉导管或卵圆孔处存在右向左或双向血流分流，并伴有三尖瓣反流（TR）射流>40mmHg，则行超声心动图检查诊断为 PPHN。所有人口统计学、孕产妇、产前、产时和产后数据均记录在预设计的表格上。
结果
共纳入 79 例患儿，其中男 61 例，女 18 例。本研究中观察到的最常见危险因素是男性（72.1%）、剖宫产分娩（54.2%）、复苏时正压通气（44.2%）、出生窒息（40.4%）和胎粪吸入综合征（MAS，35.4%）。结果显示，男性（88.8%）、剖宫产分娩（77.7%）、呼吸窘迫综合征（RDS）（44.8%）和败血症（44.4%）在早产儿中与 PPHN 的相关性较足月儿和过期儿更高。在 79 例患儿中，共有 7 例早产儿和 14 例足月儿和过期儿死亡。总的来说，剖宫产分娩（71.4%）、出生窒息（57.1%）和女性（52.4%）是与死亡率相关的主要危险因素。然而，呼吸窘迫综合征（RR=5）、出生窒息（RR=2.5）和男性（RR=2）在早产儿中与死亡率增加相关，而在足月儿和过期儿中则不相关。
结论
在任何年龄组中，男性、剖宫产分娩、MAS 和 RDS 均为 PPHN 的主要危险因素。RDS、出生窒息和男性与早产儿死亡率增加相关，而与足月儿和过期儿无关。
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