摘要
目的:分析足月儿和近足月儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)需重复应用肺表面活性物质(pulmonary surfactant,PS)的危险因素,以指导NRDS的治疗,提高合理用药水平。方法:回顾性分析2012年1月-2016年12月本院采用肺表面活性物质治疗的足月儿与近足月儿NRDS 184例,未重复使用对象纳入单次组,重复使用对象纳入重复组,对两组的情况进行对比分析。结果:重复使用71例纳入重复组,单次使用113例纳入单次组。两组的出生窒息、妊娠期高血压疾病、X线片Ⅲ~Ⅳ级、肺部感染、气胸、菌血症、肺出血、高血糖、多器官功能障碍、休克、动脉导管未闭、极危重及危险黄疸、NCPAP比重、出生体重、并发NRDS时间、使用PS时间、PaO_2、PaCO_2、pH、FiO_2、PIP、PEEP、呼吸困难改善时间比较,差异均有统计学意义(P<0.05)。多因素分析显示,X线片分级Ⅲ~Ⅳ级[OR=1.76,95%CI(1.985,4.765)]、出生窒息[OR=1.743,95%CI(1.398,14.587)]、动脉导管未闭[OR=3.195,95%CI(1.980,58.862)]、使用PS时间[OR=0.083,95%CI(1.001,1.185)]、经鼻持续正压[OR=0.77,95%CI(1.485,1.865)]均为独立影响因素。结论:足月儿和近足月儿NRDS重复应用PS与病情、治疗方式有关,需重视出生窒息的抢救,及早使用PS,必要时首剂也可预防性应用,加强通气管理。
Objective： To analyze the risk factors of repeated pulmonary surfactant in full-term infants and near full-term infants with respiratory distress syndrome, in order to guide the treatment of NRDS, improve the level of rational use of drugs.Method： The clinical data of 184 full-term and near full-term infants with NRDS treated in our hospital from January 2012 to December 2016 were analyzed retrospectively, no repeated objects were included in the single group , repeated objects were included in the repeated group, the circumstances of two groups were compared and analyzed.Result： Repeated use of 71 patients were included in the repeat group, 113 cases were included in the single group.Comparison of two groups of birth asphyxia, gestational hypertension, X-ray m-IV, pulmonary infection, pneumothorax, blood bacteria disease, pulmonary hemorrhage, hyperglycemia, multiple organ dysfunction, shock, patent ductus arteriosus, severe jaundice and risk, the proportion of NCPAP, birth weight, concurrent NRDSti/ne, PStime, PaO2, PaCO2, pH, FiO2, PIP, PEEP, and dyspneaimproved time level, the differences were no statistically significant （P〈0.05） .Multivariate analysis showed that the X-ray grade Ill-IV [OR=1.76, 95%CI （ 1.985, 4.765） ], birth asphyxia [OR=1.743, 95%CI （ 1.398, 14.587） ], patent ductus arteriosus [OR=3.195, 95%CI （ 1.980, 58.862 ） ], time to use PS[OR=0.083, 95%CI （ 1.001, 1.185 ） ], nasal continuous positive pressure[OR=0.77, 95%CI （ 1.485, 1.865 ） ] were independent influencing factors.Conclusion： The full-term infants and near full-term infants NRDS repeated application of PS and disease treatment, need to pay attention to the rescue of birth asphyxia, early use of PS, if necessary, the first agent can also be used prophylactically and strengthen the ventilation management.
出处
《中国医学创新》
CAS
2017年第21期15-18,共4页
Medical Innovation of China
关键词
足月儿
呼吸窘迫综合征
肺表面活性物质
因素分析
Full-term infants
Respiratory distress syndrome
Pulmonary surfactant
Factoranalysis
