足月儿与早产儿呼吸窘迫综合征临床对比

Clinical features of full term infants and preterm infants with respiratory distress syndrome

摘要:

目的：探讨足月儿与早产儿呼吸窘迫综合征（respiratory distress syndrome，RDS）临床特征的异同，以指导临床医师对 RDS、尤其是对足月儿 RDS 的正确防治。方法：本中心 2008 年 1 月至 2012 年 12 月收治入院日龄 <2 d的 RDS 患儿共 1 133例，按胎龄分为足月儿组与早产儿组，不同胎龄组再按病情严重程度分为轻度组与重度组，对不同组别患儿的临床资料进行对比分析。结果：轻度组早产儿 542 例（67.3%），剖宫产 353 例（65.1%），使用肺表面活性物质（pulmonary surfactant，PS）354 例（65.3%），使用 PS 48 h 内胸片改善 230 例（65.0%），辅助通气持续时间中位数为 76.0 h，并发肺气漏 41 例（7.6%）；轻度组足月儿 200 例（61.0%），剖宫产 187 例（93.5%）（与轻度组早产儿相比，下同，χ2=59.352，P=0.000），使用 PS 74 例（37.0%）（χ2=47.979，P=0.000），使用 PS 48 h 内胸片改善 35 例（47.3%）（χ2=8.108，P=0.004），辅助通气持续时间中位数为 90.0 h（Z=-2.261，P=0.024），并发肺气漏 28 例（14.0%）（ χ2=7.713，P=0.007）。重度组早产儿 263 例（32.7%），剖宫产 173 例（65.8%），使用 PS 193 例（73.4%），并发肺气漏 13 例（4.9%）；重度组足月儿 128 例（39.0%）（与重度组早产儿相比，下同， χ2=4.163，P=0.041），剖宫产 122 例（95.3%）（χ2=40.538，P=0.000），使用 PS 77 例（60.0%）（χ2=7.050，P=0.008），并发肺气漏 19 例（14.8%）（ χ2=11.231，P=0.001）。结论：（1）足月儿与早产儿 RDS 在发病的高危因素、病情严重程度、治疗效果、并发症及预后等方面有诸多不同之处，诊疗过程中需考虑胎龄因素的影响。（2）与早产儿 RDS 相比，足月儿 RDS 病情更重，易并发肺气漏，故更需重视对足月儿 RDS 的早期诊断及治疗。

Abstract:

Objective：To investigate the different clinical characteristics of respiratory distress syndrome（RDS）with various gestational ages and to guide the clinician to prevent and treat RDS correctly. Methods：A total of 1 133 cases of RDS whose admission ages were less than 2 d in our department from January 2008 to December 2012 were divided into full-term group and preterm group according to gestational age. According to illness severity，all patients were subdivided into mild group and severe group. The clinical data in each group were analyzed. Results：Mild preterm group had 542 cases（67.3%）；353（65.1%） were performed with cesarean delivery and 354（65.3%） were treated with pulmonary surfactant（PS）. Chest X-ray was improved in 230 infants（65.0%） after using PS with－in 48 h. The time for assisted ventilation was 76.0 h and 41 cases（7.6%） complicated with pulmonary air leak. Mild full-term group had 200 cases（61.0%），187（93.5%） were performed with cesarean delivery（compared with that in mild preterm group， χ2=59.352，P=0.000） and 74（37.0%） were treated with PS（χ2=47.979，P=0.000）. Chest X-ray was improved in 35 infants（47.3%） after using PS within 48 h（χ2=8.108，P=0.004）.The time for assisted ventilation was 90.0 h（Z=-2.261，P=0.024） and 28 cases（14.0%） complicated with pulmonary air leak（χ2=7.713，P=0.007）. Severe preterm group had 263 cases（32.7%）；173（65.8%） performed with cesarean de－livery and 193（73.4%） were treated with PS；13 cases（4.9%） complicated with pulmonary air leak. Severe full-term group had 128 cases（39.0%）（compared with that in severe preterm group，χ2=4.163，P=0.041）；122（95.3%） performed with cesarean delivery（χ2=40.538，P=0.000） and 77（60.0%） treated with PS（χ2=7.050，P=0.008）；19 cases（14.8%） complicated with pulmonary air leak（χ2=11.231，P=0.001）. Conclusion：（1）Different clinical characteristics between preterm RDS and full-term RDS lie in risk factors，illness severity，treatment response，complications and prognosis，etc. Gestational age should be taken into consideration when diagnosing and treating RDS. （2）Full-term RDS are characterized by clinically severity and frequently pulmonary air leak compared with that of preterm RDS，therefore more attention should be paid to its early diagnosis and treatment.