摘要
一、目的：
新生儿持续肺动脉高压(persistent pulmonary hypertension of newborn，PPHN)是指出生后，因各种病因导致肺血管阻力持续增加引起肺动脉压高于体循环压，右心腔静脉血流通过卵园孔和／或动脉导管，产生大量的右向左分流，是多种因素所致的临床综合症。随着科技进步，近年来对PPHN的研究已经取得了很大进展，使诊治有了长足的进步，国内对此也制定了相关诊疗常规，但病死率及并发症仍然处于较高水平，特别是基层单位对该症缺乏足够的认识和可靠的诊断手段，尤其欠缺彩色超声Doppler的应用，致使病情延误，错过抢救患儿的最佳时期。针对这一情况本课题通过对PPHN危险因素的研究，期望建立一种对PPHN的简便判别方法，以期能应用于基层医院(无条件使用彩色超声Doppler)对该症进行早期判别，抓住治疗时机，进一步提高医疗质量，降低病死率，远期减少伤残儿童，具有非常重要的临床意义。
二、方法：
本研究病例来自于2001年8月至2002年10月间住我院新生儿病房的低氧血症患儿143例。住院后经彩色超声Doppler检查，结合临床，根据诊断标准分出PPHN 40例和non-PPHN 103例两组，调查、核对并记录PPHN和non-PPHN患儿所有相关因素。使用SPSS 10.0统计软件，首先对两组相关变量进行单因素分析，计量资料以样本均数±标准差表示(x±S)，并做显著性检验(t检验)，计数资料按模型要求对变量进行变换(变为二分变量或等级变
硕士研究生学位论文
量)，经x之、秩和检验得出P值。最后对单因素分析有意义的变量以及理论上
认为与PPHN发生相关的变量进行综合，应用判别分析法，求出最优效应方程估
计各种危险因素对PPHN发生的影响。然后将公式应用于临床进行检验。
三、结果:
1.143例患儿中，40例确诊为PPHN，103例为non一PPHN。两组单因素
分析结果提示青紫程度，氧疗后改善情况，心脏疾患，特别是是否存在心力衰
竭，以及肺部疾患，PH、PaCOZ、PaoZ等均存在显著统计学意义，将上述变量
和理论上认为与PPHN发生相关的变量再次经统计判别分析，结果显示:胎龄、
青紫程度、氧疗后青紫改善情况、PaCO:、是否存在心力衰竭是判别发生PPHN
的高危因素，求出最优效应方程如下:
PPHN判别函数式:Y，=6.1 58X、+1 l.100XZ一6.606X3+0.573X4一0.145Xs一144.028
non一pPH丙判别函数式:
YZ=5 .922 XI+8.350 XZ一3.651 X3+0.477为一2.370Xs一127.353
(X;:胎龄;xZ:青紫程度;X3:氧疗后改善情况;为:PaCO:;XS:是否存
在心力衰竭。)
2.公式实践应用于临床30例患儿，将其各因素代入公式，如果Yl>YZ，则
判入PPHN组，否则为non一PPHN组，如Y、一Y:则应结合临床判别。本课题得
出PPHN对判率达95%，non一PpHN对判率达90%。
四、结论:
1.围生期多种因素与PPHN的发生有关，如肺部疾患、体内环境改变:PH、
Pac02、Pa02、ca+“等，以及青紫程度，氧疗后改善情况，是否存在心力衰竭
可视为PPHN的高危因素。
2.判别函数式:YL、YZ可试用于临床，如Yl>Y2.则判入PPHN组，否
硕士研究生学位论文
则为non一PPHN组，如Yl=Y:则应结合临床判别。在无条件使用彩色超声
DoPPler的医院，尤其是基层医院，将患儿转入上级医院前，应用上述公式做
出早期初步判断，抓住抢救时机，减免因PPHN恶性循环造成的严重并发症。
persistent pulmonary hypertension of newborn (PPHN), Which is a clinical syndrome, characterized by various pathogeny secondary to maintain elevated pulmonary vascular resistance after birth with resultant shunting of pulmonary blood flow to the systemic circulation by across patent foramen oval(PFO) and/or patent ductus arteriosus(PDA). With the progress of science and technology recent year, the study of PPHN has revolutionized development on the diagnose and treatment, we also have made diagnose criteria of clinical and echocardiographic on PPHN, but the mortality and complication is still on higher level, especially in the grass-roots hospital, for lacking of enough acknowledge about it and the reliable diagnose method: echocardiographic Doppler(ECHO), the disease has always been delayed. Aim at this situation, we expect to set up the earlier discriminant method of it. and apply in the grass-roots hospital, or as the early diagnose method of disease.intent to catch hold of rescue time, improve the qualit
y of medical treatment, decline the mortality and handicapped child, which has significance for clinical. Methods
The research date was obtained from newborn ward in our hospital from August 2001 to October 2002(there were 143 infant.), when patient enrolled, the Arterial blood gas analysis was taken firstly, if premature newborn was PaO:
<50mmHg or mature newborn PaOz <65mmHg, then they had ECHO, according to the diagnose criteria of clinical and ECHO, we classified them into two groups: PPHN(40) and non-PPHN(103). recorded all of the relation date. By using statistic software SPSS 10.0, we firstly analysed the link of the single fact of two group and than synthesis all of the facts which relate to the PPHN. Results
1. 40 infants were PPHN(143 case of date), 103 were non-PPHN. After analyzed by statistical software SPSS 10.0, those the degree of cyanose and improvement of PaOz /SO (after inhaling high oxygen concentrations) and heart failure and pulmonary disease and pregnancy term and PH, PaO2 , PaCO, BE had significantly difference.
pooled within-groups correlations between discriminating variables, The risk facts are drawn as follows: pregnancy term, degree of cyanose, improvement of PaO /SO (after inhaling higher concentration oxygen), PaCO2 and heart failure.
Fisher's linear discriminant functions:
PPHN:
Y=6.158X,+11.100X2-6.606X3+0.573X4-0.145X-144.028
non-PPHN:
Y=5.922 X+8.350 X-3.651 X+0.477 X4-2.370 X-127.353
(Xi: pregnancy term; X2: degree of cyanose; X3: improvement of PaO /SO (after inhaling higher flow oxygen); X: PaCO2 ; X: heart failure. )
Applied in the 30 case patient, if Y>Y2, the patient would be discriminated
to PPHN, otherwise for the non-PPHN. If,we shoud connected with clinical. in this study , the correct ratio of discriminte reached to 95% in the PPHN, non-PPHN was 90%.
This study implies that:
1. many of perinatal facts, such as pulmonary disease, heart disease, PH, PaC2, PaCO2 , BE, etc, were significantly link with PPHN. those facts which are pregnancy term and degree of cyanose and improvement of PaO2 /SO2(after inhaling high oxygen concentrations); PaCC2 and heart failure were regarded as risk facts for PPHN.
. Fisher's linear discriminant functions(Yi and 2 ) can be applied in the clinical, especially in the grass-roots hospital, try to use this function to discriminant PPHN early before transfering patient to higher hospital, catch hold of rescue time, so as to decline or prevent the severe complication of PPHN.
引文
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