2016-2017年西安市新城区新生儿呼吸窘迫综合征相关因素调查
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摘要
目的研究陕西省西安市新城区新生儿呼吸窘迫综合征(NRDS)的流行病学特征并比较LISA技术和INSURE技术的效果差异。方法对2016-03/2017-07陕西省西安市新城区10 254例新生儿进行流行病学调查,分析新生儿呼吸窘迫综合征的发病率以及发病相关因素。回顾性分析西安市第四医院68例新生儿呼吸窘迫综合征的临床资料,分为LISA组(30例)和INSURE组(38例),观察两组技术相关的不良反应及其各种并发症的发生率。结果 NRDS患儿共398例,发病率为3.88%;常见发病高危因素依次为Apgar评分过低、多胎、妊高症、胎膜早破、胎盘早剥及妊娠期糖尿病;LISA组在给药过程中发生SPO2下降比例为16.67%、心动过缓比例为13.33%,支气管肺发育不良比例为10%,均低于INSURE组,差异有统计学意义(P<0.05);两组间病死率、生后72 h机械通气、颅内出血、早产儿视网膜病、新生儿坏死性小肠结肠炎、气胸等疾病的发生率差异无统计学意义(P>0.05)。结论陕西省西安市新城区NRDS仍有一定的发病率,针对发病高危因素进行积极预防十分必要;LISA技术对NRDS患儿的治疗更安全有效,值得在临床推广。
Objective To study the epidemiological characteristic of NRDS in the new area of Xi'an city, and to compare the different result between the methods of LISA and INSURRE. Methods From March 2016 to July 2017, about 10 254 newborns were conducted epidemiological surveys,the morbidity and related factors of NRDS were analyzed. About 68 cases of NRDS in our hospital were analyzed retrospectively, they were divided into LISA group(30 cases) and INSURE group(38 cases). The incidence of adverse reactions and complications between two groups were compared. Results There were 398 newborns with NRDS, and the incidence rate was 3.88%. The risk factors included low Apgar score, polyembryony, PIH, premature rupture of membranes,placental abruption and GDM; the reduction of incidence of SP02(16.67%), bradycardia ratio(13.33%) and BPD ratio(10%) in LISA group were lower than that of INSUE group(P<0.05). There was no significant difference between the two groups in fatality rate,72 h mechanical ventilation,intracranial hemorrhage,retinopathy,neonatal necrotizing enterocolitis and pneumothorax(P>0.05). Conclusion NRDS still has a certain incidence in the new area of Xi'an city,and it is necessary to prevent the high-risk factors. LISA technology is more safe and effective for the treatment of NRDS children and it is worth to promote in clinical practice.
Objective To study the epidemiological characteristic of NRDS in the new area of Xi'an city, and to compare the different result between the methods of LISA and INSURRE. Methods From March 2016 to July 2017, about 10 254 newborns were conducted epidemiological surveys,the morbidity and related factors of NRDS were analyzed. About 68 cases of NRDS in our hospital were analyzed retrospectively, they were divided into LISA group(30 cases) and INSURE group(38 cases). The incidence of adverse reactions and complications between two groups were compared. Results There were 398 newborns with NRDS, and the incidence rate was 3.88%. The risk factors included low Apgar score, polyembryony, PIH, premature rupture of membranes,placental abruption and GDM; the reduction of incidence of SP02(16.67%), bradycardia ratio(13.33%) and BPD ratio(10%) in LISA group were lower than that of INSUE group(P<0.05). There was no significant difference between the two groups in fatality rate,72 h mechanical ventilation,intracranial hemorrhage,retinopathy,neonatal necrotizing enterocolitis and pneumothorax(P>0.05). Conclusion NRDS still has a certain incidence in the new area of Xi'an city,and it is necessary to prevent the high-risk factors. LISA technology is more safe and effective for the treatment of NRDS children and it is worth to promote in clinical practice.
引文
[1]王承峰,陈光明.肺表面活性物质在新生儿呼吸窘迫综合征治疗中的应用[J].中国妇幼保健,2013,28(10):1602-1604.
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[3]Natarajan G,Pappas A,Shankaran S,et al.Outcomes of extremely low birth weight infants with bronchopulmonary dysplasia:impact of the physiologic definition[J].Early Hum Dev,2012,88(7):509-515.
[4]王卫平.儿科学[M].7版.北京:人民卫生出版社,2013.
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[6]张娟,刘俐,王全丽,等.陕西省新生儿呼吸窘迫综合征流行病学调查[J].中国妇幼健康研究,2015,26(3):402-405.
[7]Jain L,Eaton DC.Physiology of fetal lung fluid clearance and the effect of labor[J].Semin Perinatol,2006,30(1):34-43.
[8]付惠玲,刘俐,张娟,等.西北地区三级医院不同胎龄新生儿呼吸窘迫综合征疾病特点和防治状况研究[J].中国当代儿科杂志,2015,17(10):1039-1044.
[9]Sweet DG,Camielli V,Greisen G,et al.European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants-2013update[J].Neonatology,2013,103(4):353-368.
[10]杨静.新生儿呼吸窘迫综合征防治策略研究进展[J].国际生殖健康/计划生育杂志,2012,31(5):422-425.
[11]Halamek LP,Morley C.Continuous positive airway pressure during neonatal resuscitation[J].Clin Perinatol,2006,33(1):83-98.
[12]Edmond K,Hurt L,Fenty J,et al.Effect of vitamin A supplementation in women of reproductive age on cause-specific early and late infant mortality in rural Ghana;ObaapaVitA double-blind cluster-randomised,placebo-controlled trial[J].BMJ Open,2012,2(1):e000658.
[13]郭德康.肺泡表面活性物质预防新生儿呼吸窘迫综合征的疗效[J].中国当代医药,2011,18(14):56-57.
[14]卢维城,魏海波,陈有平.经胃管微创注入肺表面活性物质在新生儿呼吸窘迫综合征中的应用[J].广东医学,2016,37(21):3233-3235.
[15]Polin RA,Carlo WA.Surfactant replacement therapy for preterm and term neonates with respiratory distress[J].Pediatrics,2014,133(1):156-163.
[2]代苗英,李少兵,胡金绘,等.不同胎龄新生儿呼吸窘迫综合征高危因素及临床分析[J].临床儿科杂志,2014,32(7):644-648.
[3]Natarajan G,Pappas A,Shankaran S,et al.Outcomes of extremely low birth weight infants with bronchopulmonary dysplasia:impact of the physiologic definition[J].Early Hum Dev,2012,88(7):509-515.
[4]王卫平.儿科学[M].7版.北京:人民卫生出版社,2013.
[5]封志纯,李丽华,孔祥永,等.晚期早产儿的临床特点及神经发育异常的风险[J].临床儿科杂志,2011,29(2):199-200.
[6]张娟,刘俐,王全丽,等.陕西省新生儿呼吸窘迫综合征流行病学调查[J].中国妇幼健康研究,2015,26(3):402-405.
[7]Jain L,Eaton DC.Physiology of fetal lung fluid clearance and the effect of labor[J].Semin Perinatol,2006,30(1):34-43.
[8]付惠玲,刘俐,张娟,等.西北地区三级医院不同胎龄新生儿呼吸窘迫综合征疾病特点和防治状况研究[J].中国当代儿科杂志,2015,17(10):1039-1044.
[9]Sweet DG,Camielli V,Greisen G,et al.European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants-2013update[J].Neonatology,2013,103(4):353-368.
[10]杨静.新生儿呼吸窘迫综合征防治策略研究进展[J].国际生殖健康/计划生育杂志,2012,31(5):422-425.
[11]Halamek LP,Morley C.Continuous positive airway pressure during neonatal resuscitation[J].Clin Perinatol,2006,33(1):83-98.
[12]Edmond K,Hurt L,Fenty J,et al.Effect of vitamin A supplementation in women of reproductive age on cause-specific early and late infant mortality in rural Ghana;ObaapaVitA double-blind cluster-randomised,placebo-controlled trial[J].BMJ Open,2012,2(1):e000658.
[13]郭德康.肺泡表面活性物质预防新生儿呼吸窘迫综合征的疗效[J].中国当代医药,2011,18(14):56-57.
[14]卢维城,魏海波,陈有平.经胃管微创注入肺表面活性物质在新生儿呼吸窘迫综合征中的应用[J].广东医学,2016,37(21):3233-3235.
[15]Polin RA,Carlo WA.Surfactant replacement therapy for preterm and term neonates with respiratory distress[J].Pediatrics,2014,133(1):156-163.