摘要
目的 参照柏林会议标准探讨新生儿重度急性呼吸窘迫综合征（ARDS）的诊断、治疗及预后.方法 回顾性分析华中科技大学同济医学院附属同济医院2005年1月至2013年12月收治的86例新生儿重度ARDS患儿的诊断、治疗、胸部X线特点、病死率、并发症发生情况及使用呼吸机参数等临床资料.结果 （1） 86例患儿治愈55例,死亡31例,病死率36.0％ （31/86）;（2）入院胸部X线片示双肺透亮度降低呈毛玻璃状,肺纹理粗乱或可见小点片状或斑片状阴影者36例;双肺弥漫性浸润影且有大片融合实变,可见“支气管充气征”者26例;心影、膈面不清,甚至呈“白肺”改变者24例;（3）合并持续肺动脉高压（PPHN）者68例,发生率79.1％ （68/86）;（4）将86例患儿分为存活组和死亡组,结果显示,与存活组比较,死亡组上呼吸机前所需FiO2更高、PaO2及PaO2/FiO2更低（P＜0.01）,且上呼吸机后所需吸气峰压（PIP）初调值更高（P＜0.01）.结论 新生儿ARDS病情危重,病死率高;目前尚缺乏统一的诊断标准;对其治疗,应是在给予相应呼吸支持治疗基础上的综合治疗.
Objective To investigate the diagnosis,treatment and prognosis of neonates with severe acute respiratory distress syndrome （ARDS） according to Berlin definition.Methods A retrospective study was carried to analyze the clinical features about diagnosis,treatment,chest X-ray findings,mortality,complications and ventilator parameters in 86 neonates with severe ARDS admitted in the NICU from January 2005 to December 2013.Results （1）Among the 86 cases,55 were cured,and 31 died with 36.0% mortality.（2） Chest X-ray showed there was decreased lucency of bilateral lungs with ground-glass appearance,lung texture with thick chaos or dot flakes or patchy shadows in 36 neonates; diffuse infiltrates and extensive confluent consolidation shadows in bilateral lungs along with peripheral air brornchograms in 26 cases; heart shadow and diaphragmatic surface disappeared like a ＆quot;white lung＆quot; change in 24 cases.（3） Persistent pulmonary hypertension of newborn as a complication occurred in 68 cases with 79.1% incidence.（4） Eighty-six cases were categorized into survival group and death group.The results showed compared with the survival group,the neonates in death group required higher FiO2,and PaO2,and lower PaO2/FiO2 before mechanical ventilation （P 〈 0.01）,but needed higher initial PIP of mechanical ventilation （P 〈 0.01）.Conclusions Neonatal ARDS is still a kind of critical condition with high mortality and lack of evidence-based diagnostic criteria so far.The therapeutic strategy for neonatal ARDS should be a comprehensive measures in addition to appropriate respiratory support.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2015年第3期258-262,共5页
Chinese Journal of Emergency Medicine
基金
国家自然科学基金（81370099）
2011国家临床重点专科建设项目
“十五”国家科技攻关计划资助项目（2004BA720A11）
湖北省自然科学基金资助项目（2013CFB087）
华中科技大学自主创新研究基金（国际科技合作专项2014XJGH008）
关键词
急性呼吸窘迫综合征
诊断
治疗
新生儿
回顾性分析
Acute respiratory distress syndrome
Diagnosis
Treatment
Neonate
Retrospective analysis
