鄂西南地区新生儿急性呼吸窘迫综合征临床流行病学调查

A clinical epidemiological investigation of neonatal acute respiratory distress syndrome in southwest Hubei, China

摘要:

目的 了解鄂西南地区新生儿急性呼吸窘迫综合征（ARDS）的临床特点及转归。方法 采用回顾性临床流行病学方法，根据新生儿ARDS蒙特勒诊断标准对2017年1~12月鄂西南地区17家二级或三级医院新生儿科/儿科收治的新生儿ARDS病例资料进行调查分析。结果 所纳入的鄂西南地区17家医院2017年1年内共收治新生儿7 150例，其中确诊新生儿ARDS 66例（0.92%），包括轻度23例（35%），中度28例（42%），重度15例（23%）。新生儿ARDS的主要原发疾病包括：围生期窒息（23例，35%）、肺炎（18例，27%）、败血症（12例，18%）、胎粪吸入综合征（10例，15%）。66例ARDS患儿中，产妇年龄≥35岁10例（15%），宫内窘迫30例（45%），1 min Apgar评分0~7分32例（49%），胎心监测异常24例（36%），羊水胎粪污染21例（32%）。脑室内出血是最常见的合并症（12例），其次为新生儿休克（9例）、动脉导管未闭（8例）。66例ARDS患儿在针对原发病治疗的基础上，均给予机械通气治疗。死亡10例，病死率为15%（10/66）；治愈、好转56例（85%）。结论 鄂西南地区新生儿ARDS以轻/中度为主；围生期窒息和感染可能是该地区新生儿ARDS的主要病因；脑室内出血是最常见的合并症；综合治疗后患儿存活率较高。

Abstract:

Objective To investigate the clinical features and outcome of neonatal acute respiratory distress syndrome (ARDS) in southwest Hubei, China. Methods According to the Montreux definition of neonatal ARDS, a retrospective clinical epidemiological investigation was performed on the medical data of neonates with ARDS who were admitted to Department of Neonatology/Pediatrics in 17 level 2 or level 3 hospitals in southwest Hubei from January to December, 2017. Results A total of 7 150 neonates were admitted to the 17 hospitals in southwest Hubei during 2017 and 66 (0.92%) were diagnosed with ARDS. Among the 66 neonates with ARDS, 23 (35%) had mild ARDS, 28 (42%) had moderate ARDS, and 15 (23%) had severe ARDS. The main primary diseases for neonatal ARDS were perinatal asphyxia in 23 neonates (35%), pneumonia in 18 neonates (27%), sepsis in 12 neonates (18%), and meconium aspiration syndrome in 10 neonates (15%). Among the 66 neonates with ARDS, 10 neonates (15%) were born to the mothers with an age of ≥ 35 years, 30 neonates (45%) suffered from intrauterine distress, 32 neonates (49%) had a 1-minute Apgar score of 0 to 7 points, 24 neonates (36%) had abnormal fetal heart monitoring results, and 21 neonates (32%) experienced meconium staining of amniotic fluid. Intraventricular hemorrhage was the most common comorbidity (12 neonates), followed by neonatal shock (9 neonates) and patent ductus arteriosus (8 neonates). All 66 neonates with ARDS were treated with mechanical ventilation in addition to the treatment for primary diseases. Among the 66 neonates with ARDS, 10 died, with a mortality rate of 15% (10/66), and 56 neonates were improved or cured, with a survival rate of 85% (56/66). Conclusions Neonatal ARDS in southwest Hubei is mostly mild or moderate. Perinatal asphyxia and infection may be the main causes of neonatal ARDS in this area. Intraventricular hemorrhage is the most common comorbidity. Neonates with ARDS tend to have a high survival rate after multimodality treatment.