新生儿呼吸窘迫综合征高危因素893例分析
- 曲雯雯1,2,范含笑1,谢露1,韩笑1,尹晓娟1,2
作者信息
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Analysis the risk factors of 893 cases of neonatal respiratory distress syndrome
- QU Wen-wen1,2,FAN Han-xiao1,XIE Lu1,HAN Xiao1,YIN Xiao-juan1,2
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文章历史
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摘要
目的 探讨新生儿呼吸窘迫综合征(respiratory distress syndrome,RDS)发病的高危因素,为临床治疗提供参考依据。方法 对2007年1月-2012年10月在八一儿童医院新生儿监护病房住院确诊为RDS的893例新生儿进行回顾性研究。根据胎龄分为足月儿组(148例)和早产儿组(745例),将两组的性别、胎龄、出生体重、分娩方式、窒息、胎盘异常、胎膜早破、宫内感染、胎粪吸入综合征、孕母糖尿病、孕母高血压指各标进行组内及组间比较。采用SPSS 19.0对数据进行统计分析。结果 单因素方差分析显示男性、剖官产、宫内感染、宫内窘迫是足月儿RDS发生的高危因素,早产、胎膜早破、孕母高血压、出生窒息是早产儿RDS发病的高危因素,多因素Logistic回归分析提示,胎龄、分娩方式、出生体重、胎膜早破、出生窒息、孕母糖尿病、孕母高血压、宫内感染为RDS发病危险因素(P<0.05),各因素在RDS发生中作用的大小顺序依次为:剖宫产＞孕母高血压＞宫内感染＞出生体重＞孕母糖尿病＞出生窒息(OR值分别为71.136、66.117、65.824、38.565、4.935、1.940)。结论 RDS的发生是多因素的,早产、剖宫产、宫内感染、窒息缺氧、孕母高血压、孕母糖尿病等与新生儿呼吸窘迫综合征的发生密切相关,临床应予以重视。
Abstract
Objective To investigate the high risk factors of neonatal respiratory distress syndrome (RDS). Methods A retrospective data analysis method,893 cases of RDS infants were chosen in the neonatal intensive care unit in Bayi Hospital from January 2007 to October 2012.Depending on gestational age,they were divided into full-term children group (148 cases) and preterm children group(745 cases).Compared the gender,gestational age,birth weight,mode of delivery,asphyxia,placental problem,premature rupture of fetal membranes,intrauterine infection,meconium aspiration syndrome,maternal diabetes,maternal hypertension within the group and between groups,the data were analyzed by SPSS 19.0. Results Single factor analysis indicated that male,cesarean section,intrauterine infection,intrauterine distress were associated with RDS in full-term infants.Premature birth,premature rupture of membranes,maternal hypertension,asphyxia were risk factors of RDS in the preterm infants.Multivariate logistic regression analysis showed high risk factors and the role of various factors in the RDS disease occur in the size were cesarean section> intrauterine infection> maternal hypertension> birth weight> maternal diabetes> birth asphyxia(OR was for 71.136,66.117,65.824,38.565,4.935,1.940 respectively). Conclusions Many high risk factors are associated with RDS,premature birth,cesarean delivery,intrauterine infection,birth asphyxia,maternal hypertension,maternal diabetes are closely associated with RDS.These clinical factors should be given more attention.
关键词
新生儿呼吸窘迫综合征 / 高危因素 / Logistic回归分析
Key words
neonatal respiratory distress syndrome / high risk factors / Logistic regression analysis
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参考文献
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[2] Kramer BW.The respiratory distress syndrome in preterm infant:physiology,prophylaxis and new threapeutic approaches[J].Intensiv Med,2007,44(2):403-408.
[3] 尹晓娟,李丽华,王艳,等.新生儿呼吸窘迫综合征患儿肺表面活性物质蛋白B表达的研究[J].中国新生儿科杂志,2011,26(5):336-339.
[4] de Abreu LC,Valenti VE,de Oliveira AG,et al.Chest associated to motor physiotherapy improves cardiovascular variables in newborns with respiratory distress syndrome[J].Int Arch Med,2011,4:37-45.
[5] Mazela J,Merritt TA,Gadzinowski J,et al.Evolution of pulmonary surfactants for the treatment of neonatal respiratory distress syndrome and paediatric lung disease[J].Acta Paediatr,2006,95(9):1036-1048.
[6] Clark RH.The epidemiology of respiratory failure in neonates born at an estimated gestational age of 34 weeks or more[J].J Perinatol,2005,25(4):251-257.
[7] 邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].4版.北京:人民卫生出版社,2011:395-397.
[8] Clark RH.The epidemiology of respiratory failure in neonates born at an estimated gestational age of 34 weeks or more[J].J Perinatol,2005,25:251-257.
[9] Curstedt T,Johansson J.New synthetic surfactants-basic science[J].Biol Neonate,2005,87:332-337.
[10] Clair St C,Norwitz ER,Woensdregt K,et al.The probability of neonatal respiratory distress syndrome as a function of gestational age and lecithin/sphingomyelin ratio[J].Am J Perinatol,2008,25(8):473-480.
[11] Lyra PPR,Diniz EMA,Abe-Sandes K,et al.Surfactant protein B gene polymorphism in preterm babies with respiratory distress syndrome[J].Braz J Med Biol Res,2011,44(1):66-72.
[12] Sweet DG,Halliday HL.The use of surfactants in 2009[J].Arch Dis Child Educ Pract Ed,2009,94:78-83.
[13] Abdel-Latif ME,Oei J,Ward M,et al.Galvanised by a respiratory distress diagnosis[J].Arch Dis Child Educ Pract Ed,2008,93:112-119.
[14] Yin XJ,Li LH,Fan HX,et al.Correlation between surfactant protein B mRNA expression and neonatal respiratory distress syndrome[J].Exp Ther Med,2012,4(5):815-819.
[15] Hanvas A,Cole FS,Nogee LM.Genetic disorders of surfactant proteins[J].Neonatology,2007,91:311-317.
基金
国家自然科学基金资助项目(30871397)
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