摘要
目的：对比研究因呼吸衰竭(NRF)需行机械通气的足月儿与早产儿临床发病、治疗、及预后情况,分析各组NRF的构成比及病死率、疾病构成、呼吸治疗情况、并发症等方面的特点,为帮助今后提高呼吸治疗水平提供依据。
方法：将2008年收入青岛市妇女儿童医疗保健中心新生儿科NICU发生呼吸衰竭需进行辅助通气治疗的151例患儿分成足月儿组(n=56)、晚期早产儿组(n=30)和非晚期早产儿组(n=65)。采用填写调查表的形式记录相关资料和数据。设计两份表格,一是《新生儿呼吸衰竭基本信息表》,记录母亲产前检查及疾病情况等；患儿产前及出生时状况,疾病诊断、临床治疗、预后、住院天数及费用等；二是《新生儿呼吸衰竭辅助通气表》,记录通气模式、呼吸机参数(包括FiO2、PIP、MAP、PEEP和呼吸频率RR)、动脉血气分析值及经皮血氧饱和度(TcSO2)监测值。并调查2008年全年住院病人数。
结果：①2008年我院共收治足月儿838例,晚期早产儿396例,非晚期早产儿702例,行机械通气的患儿分别为56例、30例、65例,其各自的构成比分别为6.7%、7.6%、9.3%,以非晚期早产儿组最高。②构成NRF的主要原发病：足月儿组为PI和AFAP,分别占37.5%和17.9%；晚期早产儿为PI和RDS,分别占43.3%和40%；非晚期早产儿为RDS、PI和APNEA,分别占64.6%、9.2%和9.2%。③呼吸治疗情况：三组患儿均以常频通气方式(CMV)为主,上机后机体氧合及高碳酸血症均较前有明显改善。PS主要用于非晚期早产儿重度RDS的治疗,用否PS疗效及预后差异有统计学意义。④晚期早产儿预后最好,足月儿和非晚期早产儿放弃治疗比例较高。⑤足月NRF患儿主要并发症为获得性肺部感染、气漏和肺出血,均占5.4%；晚期早产儿组为气漏、获得性肺部感染、PDA,分别占16.7%、13.3%、6.7%；非晚期早产儿组主要为获得性肺部感染、IVH,分别占13.8%、6.2%。⑥三组患儿平均住院时间及费用以非晚期早产儿组最高。
结论：①我院各组NRF患儿构成比以非晚期早产儿组最高。②三组NRF患儿的主要原发病构成不同,足月儿组主要为P工和AFAP,晚期早产儿组为P工和RDS,非晚期早产儿组为RDS。③呼吸治疗方面三组患儿均以常频通气模式为主,通气后机体氧合及高碳酸血症明显改善；PS主要用于非晚期早产儿重度RDS的治疗,且疗效显著。④晚期早产儿预后最好,足月儿和非晚期早产儿放弃治疗比例较高。⑤获得性肺部感染为其最常见并发症。⑥三组患儿平均住院时间及费用以非晚期早产儿组最高。
Objective:to study the incidence, therapy and outcome of neonatal respiratory failure in full-term and premature infants required mechanical ventilation. To analyze the characteristic of each group, improve the NRF remedy level in the future.
Method:The 151 NRF infants who were admitted to the neonatal intensive care unit (NICU) of the Childrens Hospital of Qing Dao between January 2008 and December 2008 were divided into full-term infants group (n=56), late preterm infants (n=30), non-late preterm group (n=65). Design of two forms, one is "basic information sheet of neonatal respiratory failure", to record prenatal history, health condition of mother, status of infants and problems at delivery; primary disease, respiratory care, complications, prognosis and disease burden. Another is "assisted ventilation form of neonatal respiratory failure", recorded ventilation mode, ventilation parameters (FiO2, PIP, MAP, PEEP, and respiratory rate RR), arterial blood gas and percutaneous oxygen saturation (TcSO2). And to investigate the number of patients in 2008.
Result:①A total of 1936 hospitalized newborns were enrolled, of which 838 cases of full term infants,396 cases of late preterm infants,702 cases of non-late preterm infants.151 patients developed NRF in 2008, including full-term infants 56 cases, late preterm infants 30cases, non-late preterm 65 cases, the composition of their respective ratios were 6.7%,7.6%,9.3%. There was no significant difference among the three.②The cause of NRF:full term infants were Pulmonary Infection (37.5%), Amniotic Fluid Aspiration Pneumonitis (17.9%); late preterm infants were Pulmonary Infection (43.3%), Respiratory Distress Syndrome (40%); non-late preterm infants were Respiratory Distress Syndrome (64.6%), Pulmonary Infection (9.2%), Apnea (9.2%).③The main ventilation mode is conventional mechanical ventilation of all the three groups, there is no significant difference among the threegroups. Pulmonary Surfactant was mainly used for late preterm children with severe RDS, there were significant difference between use and unuse Pulmonary Surfactant.④Full-term infants with NRF:cured, abandon treatment and mortality rates were 57.1%,42.9% and 0%; late preterm infants group were 80%,16.7%, 3.3%; non-late preterm group were 60%,33.8%,6.2%. There was significant difference between full-term infants and late preterm (P=0.034); There was no significant difference between full-term infants and non-late preterm (P=0.75); There was no significant difference between late preterm infants and non-late preterm (P=0.055).⑤The incidences of major complicated acquired pulmonary infection, air leak and pulmonary hemorrhage, were 5.4%,5.4%,5.4% in full term infants; in late preterm infants air leak, acquired pulmonary infection, Patent Ductus Arteriosus were 16.7%、13.3%、6.7% respectively; in non-late preterm infants acquired pulmonary infection, intraventricular Hemorrhage were 13.8%、6.2% respectively. There were no significant difference among the three group in the major complications.
Conclusion①The incidence of NRF in our hospital was 7.8%, lower than that reported in china; There were no significant difference among the three group in the incidence of NRF.②The common complication in three groups were difference, Pulmonary Infection, Amniotic Fluid Aspiration Pneumonitis were the common complication in full term infants, Pulmonary Infection and Respiratory Distress Syndrome were the common complication in late preterm infants, non-late preterm infants were Respiratory Distress Syndrome, Pulmonary Infection and Apnea.③The main ventilation mode is conventional mechanical ventilation of all the three groups, the duration of ventilation is similar, mechanical ventilation can improve oxygenation and dropped hyercarbia remarkably. Pulmonary Surfactant was mainly used for non-late preterm infants with severe RDS treatment and has good effects on NRDS.④The prognosis of late preterm infants compared with full-term children is good, there were no significant difference between full term infants and late preterm infants, late preterm infants and non-late preterm infants.⑤Acquired pulmonary infection as its most common complications.
引文
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