PDF(1270 KB)
PDF(1270 KB)
PDF(1270 KB)
基于“蒙特勒标准”的新生儿急性呼吸窘迫综合征的单中心回顾性研究
A single-center retrospective study of neonatal acute respiratory distress syndrome based on the Montreux definition
目的 参考"蒙特勒标准"对新生儿急性呼吸窘迫综合征（NARDS）进行回顾性研究，了解NARDS的流行病学、临床特征、治疗现状、预后的相关因素。方法 回顾2017年1月至2018年7月住院患儿的病历资料，选择符合"蒙特勒标准"的314例NARDS患儿为研究对象。依据氧指数分为轻度NARDS组（n=130）、中度NARDS组（n=117）、重度NARDS组（n=67），比较各组临床特征，分析不同严重程度NARDS的危险因素和住院时长的影响因素。结果 NARDS患儿占同期新生儿病房收治患儿的2.46%（314/12 789），病死率为9.6%（30/314）。多因素有序logistic回归分析显示，使用过肺表面活性物质（PS）、辅助通气天数长的患儿NARDS较重的风险相对更大（P < 0.05）。Cox回归分析显示，低体重/巨大儿、早产儿、使用有创通气、使用过PS、病原学检测阳性等因素延长住院日的风险高（P < 0.05）。结论 避免早产、减少低体重儿/巨大儿的出生、预防围生期感染，有助于降低重症NARDS的风险。需要有创通气、长时间辅助通气、或PS治疗的患儿预后欠佳。
Objective To investigate the epidemiology, clinical features, treatment, and prognostic factors of neonatal acute respiratory distress syndrome (NARDS) through a retrospective study of NARDS based on the Montreux definition. Methods A retrospective analysis was performed on the medical records of neonates who were hospitalized from January 2017 and July 2018, among whom 314 neonates who met the Montreux definition were enrolled as subjects. According to oxygen index, they were divided into a mild NARDS group with 130 neonates, a moderate NARDS group with 117 neonates, and a severe NARDS group with 67 neonates. The clinical features were compared among the three groups to investigate the influencing factors for the severities of NARDS and the length of hospital stay. Results The neonates with NARDS accounted for 2.46% (314/12 789) of the neonates admitted to the neonatal ward during the same period of time and had a mortality rate of 9.6% (30/314). The multivariate ordinal logistic regression analysis showed that the neonates who used pulmonary surfactant (PS) or had a long duration of assisted ventilation tended to have a higher risk of severe NARDS (P < 0.05). The Cox regression analysis showed that the neonates with low birth weight/macrosomia, preterm birth, invasive ventilation, PS therapy, or positive pathogenic detection had a higher risk of prolonged hospital stay (P < 0.05). Conclusions Preterm birth, low birth weight/macrosomia, and perinatal infection may be associated with an increased risk of severe NARDS. The neonates requiring invasive ventilation, prolonged assisted ventilation, or PS therapy tend to have a poor prognosis.
急性呼吸窘迫综合征 / 蒙特勒标准 / 流行病学 / 预后 / 新生儿
Acute respiratory distress syndrome / Montreux definition / Epidemiology / Prognosis / Neonate
[1] ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome:the Berlin definition[J]. JAMA, 2012, 307(23):2526-2533.
[2] Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome:consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference[J]. Pediatr Crit Care Med, 2015, 16(5):428-439.
[3] De Luca D, van Kaam AH, Tingay DG, et al. The Montreux definition of neonatal ARDS:biological and clinical background behind the description of a new entity[J]. Lancet Respir Med, 2017, 5(8):657-666.
[4] 中国新生儿急性呼吸窘迫综合征研究协作组. 基于蒙特勒标准诊断新生儿急性呼吸窘迫综合征多中心横断面调查和影响因素分析[J]. 中国循证儿科杂志, 2018, 13(1):70-74.
[5] 王创. 统计假设检验中显著性水平α的选择[D]. 兰州:兰州商学院, 2013.
[6] 喻文亮, 钱素云, 朱友荣, 等. 小儿急性呼吸窘迫综合征病死相关因素前瞻性多中心分析[J]. 中华医学杂志, 2007, 87(46):3295-3297.
[7] 许峰, 王荃, 钱素云. 2015年版"儿童急性呼吸窘迫综合征:儿童急性肺损伤会议共识推荐"指南解读[J]. 中华儿科杂志, 2016, 54(5):323-326.
[8] Schouten LR, Veltkamp F, Bos AP, et al. Incidence and mortality of acute respiratory distress syndrome in children:a systematic review and meta-analysis[J]. Crit Care Med, 2016, 44(4):819-829.
[9] Foglia EE, Jensen EA, Kirpalani H. Delivery room interventions to prevent bronchopulmonary dysplasia in extremely preterm infants[J]. J Perinatol, 2017, 37(11):1171-1179.
[10] 迟明, 梅亚波, 封志纯. 新生儿急性呼吸窘迫综合征研究进展[J]. 中国当代儿科杂志, 2018, 20(9):724-728.
[11] Seethala RR, Hou PC, Aisiku IP, et al. Early risk factors and the role of fluid administration in developing acute respiratory distress syndrome in septic patients[J]. Ann Intensive Care, 2017, 7(1):11.
[12] Nanchal RS, Truwit JD. Recent advances in understanding and treating acute respiratory distress syndrome[J]. F1000Res, 2018, 7:F1000 Faculty Rev-1322.
[13] Mokra D, Calkovska A. Experimental models of acute lung injury in the newborns[J]. Physiol Res, 2017, 66(Suppl 2):S187-S201.
[14] Marseglia L, D'Angelo G, Granese R, et al. Role of oxidative stress in neonatal respiratory distress syndrome[J]. Free Radic Biol Med, 2019, 142:132-137.
[15] Cools F, Offringa M, Askie LM. Elective high frequency oscillatory ventilation versus conventional ventilation for acute pulmonary dysfunction in preterm infants[J]. Cochrane Database Syst Rev, 2015(3):CD000104.
[16] 周伟, 荣箫. 高频振荡通气在新生儿的应用[J]. 中国新生儿科杂志, 2012, 27(4):217-222.
[17] Keszler M. Mechanical ventilation strategies[J]. Semin Fetal Neonatal Med, 2017, 22(4):267-274.
[18] 郭静雨, 陈龙, 史源. 2017年新生儿急性呼吸窘迫综合征蒙特勒诊断标准解读[J]. 中华儿科杂志, 2018, 56(8):571-574.
[19] Schmidt A, Sempsrott J. Surfactant for acute respiratory distress syndrome caused by near drowning in a newborn[J]. Pediatr Emerg Care, 2016, 32(1):e1.
[20] Natarajan CK, Sankar MJ, Jain K, et al. Surfactant therapy and antibiotics in neonates with meconium aspiration syndrome:a systematic review and meta-analysis[J]. J Perinatol, 2016, 36(Suppl 1):S49-S54.
[21] Taut FJ, Rippin G, Schenk P, et al. A search for subgroups of patients with ARDS who may benefit from surfactant replacement therapy:a pooled analysis of five studies with recombinant surfactant protein-C surfactant (Venticute)[J]. Chest, 2008, 134(4):724-732.
[22] Duggal A, Ganapathy A, Ratnapalan M, et al. Pharmacological treatments for acute respiratory distress syndrome:systematic review[J]. Minerva Anestesiol, 2015, 81(5):567-588.
