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目的了解新生儿肺透明膜病(HMD)生后第2周(晚期)是否会出现呼吸功能恶化,以及是否晚期需要重复使用肺表面活性物质(PS)及疗效如何。方法对我院3年共89例新生儿HMD临床资料进行回顾性分析。根据是否使用PS及使用的早晚将患儿分为早期使用组、晚期重复使用组、未使用组3组,对3组患儿的一般临床情况、呼吸支持情况、呼吸严重程度评分、转归进行分析。结果发现其中16例(18%)需晚期(生后2周后)重复使用PS。这些患儿胎龄和出生体重均较低[分别为(31.0±1.5)周和(1734±165)g];脑室内出血、早产儿视网膜病和支气管肺发育不良的发生率、病死率和住院时间均明显升高;接受机械通气或nCPAP的时间明显比其他两组长,且更多采用了多种呼吸支持模式;晚期使用PS后48h内的累计呼吸严重程度评分明显下降。结论部分患儿由于PS使用后耗竭,需晚期重复用药。这一发现有利于全面评估新生儿HMD的进程。
Objective To investigate whether there is a worsening of respiratory function in neonates with hyaline membrane disease (HMD) at the second week after birth and whether the use of pulmonary surfactant (PS) should be repeated later and the curative effect. Methods A total of 89 cases of neonatal HMD in our hospital for 3 years were retrospectively analyzed. According to whether the use of PS and the use of the sooner or later, children were divided into early use group, late re-use group, unused group 3 groups, the general clinical situation of children in three groups, respiratory support, respiratory severity score, outcome analysis. RESULTS: Sixteen (18%) of these patients required repeated PS (two weeks after birth). These patients had lower gestational age and birth weight [(31.0 ± 1.5) weeks and (1734 ± 165) g, respectively]; incidence of intraventricular hemorrhage, retinopathy of prematurity and bronchopulmonary dysplasia, mortality and length of stay Were significantly higher than those of the other two groups, and the time spent on mechanical ventilation or nCPAP was significantly longer than that of the other two groups, and the multiple modes of respiratory support were more frequently adopted. The cumulative respiratory severity score within 48 hours after PS administration was significantly decreased. Conclusion Some children due to depletion of PS after use, need to be repeated late medication. This finding is conducive to a comprehensive assessment of the process of neonatal HMD.