摘要
目的利用肺部超声(LUS)观察经阴道产和剖宫产足月儿出后2 d内肺液清除过程,以期为临床指导治疗提供借鉴。方法选取2015-11-13至2016-04-10在温州医科大学附属第一医院产科出生的新生儿50例为研究对象。根据分娩方式,将新生儿分为经阴道产组(23例)和剖宫产组(27例);根据是否发生新生儿暂时性呼吸困难(TTN),将其分为TTN组(8例)和非TTN组(42例)。收集新生儿一般资料,分别于出生时(出生6 h内)、出生后第1天(6~24 h)、出生后第2天(24~48 h)进行LUS检查,根据LUS视野内B线的量及密集程度,将LUS检查结果分为Ⅰ~Ⅳ级,其中Ⅰ~Ⅲ级定义为异常,Ⅳ级定义为正常。结果剖宫产组胎龄小于经阴道产组,母亲分娩时接受麻醉率、双胎妊娠率大于经阴道产组(P<0.05)。TTN组5 min Apgar评分低于非TTN组,出生时接受呼吸支持治疗率、出生后接受呼吸支持治疗率高于非TTN组(P<0.05)。经阴道产组与剖宫产组出生时、出生后第1天、出生后第2天LUS分级比较,差异均无统计学意义(P>0.05)。剖宫产组出生时LUS异常率高于经阴道产组(P<0.05);经阴道产组与剖宫产组出生后第1天、出生后第2天LUS异常率比较,差异无统计学意义(P>0.05)。经阴道产组出生后第2天LUS异常率低于本组出生时(P<0.05);剖宫产组出生后第1天、出生后第2天LUS异常率低于本组出生时,出生后第2天LUS异常率低于本组出生后第1天(P<0.05)。TTN组与非TTN组出生时、出生后第1天LUS分级比较,差异无统计学意义(P>0.05);TTN组出生后第2天LUS分级差于非TTN组(P<0.05)。TTN组与非TTN组出生时、出生后第1天LUS异常率比较,差异无统计学意义(P>0.05);TTN组出生后第2天LUS异常率高于非TTN组(P<0.05)。结论与经阴道产新生儿相比,剖宫产新生儿的肺液清除在出生后6 h内存在障碍,但此差异在出生后6~24 h即消失。LUS可以动态观察新生儿肺液清除过程,可指导临床呼吸支持治疗,�
Objective To evaluate the process of lung fluid clearance in term neonates born by different delivery modes（ vaginal delivery or cesarean section） within 2 days after birth via lung ultrasound（ LUS）, in order to provide a reference for clinical management. Methods Fifty term neonates born in Obstetrics Department of the First Affiliated Hospital of Wenzhou Medical University from November 13 th,2015 to April 10 th,2016 were selected and divided into vaginal delivery group（ 23 cases） and cesarean section group（ 27 cases） according to the delivery mode. Besides,transient tachypnea of the newborn（ TTN） group（ 8 cases） and non-TTN group（ 42 cases） were divided according to whether presenting with TTN. Baseline data of these neonates were collected. LUS was respectively performed at birth（ within 6 h after birth）,on the 1 st day（ 6 h to 24 h after birth） and the 2 nd day（ 24 h to 48 h after birth） after birth. According to the amount and intensity of B lines within LUS field,LUS results were divided into four grades： grade Ⅰ to grade Ⅲ were defined as abnormal while grade Ⅳwas defined as normal. Results Neonates of cesarean section group had younger gestational age,but higher rate of mothers who received anesthesia during labor and had twin pregnancy compared with those of vaginal delivery group（ P 〈 0. 05）. Neonates of TTN group had lower Apgar score at 5 minutes,but higher rates of respiratory support treatment at birth and after birth compared with those of non-TTN group（ P 〈 0. 05）. There were no significant differences in LUS grades at birth,on the 1 st day or the2 nd day after birth between vaginal delivery group and cesarean section group（ P 〈 0. 05）. Exclusively at birth,rate of abnormal LUS findings of cesarean section group was significantly higher than that of vaginal delivery group（ P 〈 0. 05）; while it was similar in both groups on the 1 st day or the 2 nd day after birth（ P 〈 0. 05）. The rate of abnormal LUS findings on the 2 n
出处
《中国全科医学》
CAS
北大核心
2017年第36期4560-4566,共7页
Chinese General Practice
关键词
肺
超声检查
多普勒
足月分娩
分娩
产道
剖宫产术
新生儿一过性呼吸急促
肺液清除
Lung
Ultrasonography, doppler
Term birth
Labor, obstetric
Cesarean section
Transienttachypnea of the newborn
Lung fluid clearance
