河北省儿童医院新生儿呼吸衰竭的前瞻性临床流行病学调查

Prospective clinical survey of respiratory failure in neonates from the Children’s Hospital of Hebei Province

摘要:

目的：新生儿呼吸衰竭（NRF）是导致新生儿死亡的重要原因之一。该文对2004~2005年河北省儿童医院新生儿重症监护室（NICU）中呼吸衰竭的临床发病及治疗、预后等情况进行资料搜集及分析，以反映目前新生儿呼吸危重病的救治状况，并为今后进行大规模、前瞻性的队列研究奠定基础。方法：对2004~2005年收入NICU的304例呼吸衰竭患儿进行前瞻性资料收集及统计分析。结果：在连续12个月间，304例NRF患儿占同期NICU收治危重患儿的35.7%；新生儿呼吸窘迫综合征，羊水吸入性肺炎，社区感染性肺炎等是NRF的主要构成疾病；NRF患儿的院内病死率为5.6%（17例），放弃治疗比例达31.6%（96例）；治愈和好转出院的191例NRF患儿中，住院总天数平均为14.9±7.1 d，住院总费用平均为7 977±3 426元。结论：新生儿呼吸衰竭是本地区NICU一个高发病率、高病死率以及高住院费用的严峻问题，提示加强围生期的保健以及出生后呼吸救治新技术以及新模式的应用，提高NRF的救治成功率，可能有利于降低与围产关系密切的新生儿危重呼吸疾病的发病率及死亡率。

Abstract:

OBJECTIVE: Neonatal respiratory failure (RF) is a serious clinical problem associated with high mortality. This study aimed to investigate the incidence and outcome of neonatal RF in the Children's Hospital of Hebei Province. METHODS: The medical data of 304 RF infants who were admitted to the neonatal intensive care unit (NICU) of the Children's Hospital of Hebei Province between March 2004 and February 2005 were prospectively studied. RESULTS: The incidence of RF was 35.7% in the NICU during the 12-month period. Respiratory distress syndrome (28.4%), amniotic fluid aspiration syndrome (22.9%), and pneumonia (14.7%) were leading diseases resulting in RF. Of the 304 pati-ents, 17 (5.6%) died of RF, 96 (31.6%) discontinued therapy on account of various causes and 191 (62.8%) recovered or improved. The mean length of hospital stay was 14.9±7.1 days and the mean medical cost was 7 977±3 426 CNY for the 191 survivors.CONCLUSIONS: The morbidity, mortality and medical costs of neonatal RF are high in Hebei Province. It is essential to improve the quality in respiratory therapy and perinatal care in order to reduce the morbidity and mortality related to high-risk pregnancies.