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目的探讨足月儿和近足月儿呼吸窘迫综合征(RDS)需重复应用肺表面活性物质(PS)治疗的高危因素。方法回顾性分析我院新生儿重症监护病房2012年1月至2014年12月应用牛肺表面活性物质治疗的足月和近足月RDS患儿临床资料,根据应用PS次数分为单次组和重复组,比较两组患儿一般情况、基础疾病、应用PS日龄和剂量等,并行多因素Logistic回归分析。结果共纳入130例,其中单次组85例,重复组45例,PS重复使用率34.6%。重复组出生窒息、母亲妊娠期高血压、治疗前胸部X线片RDSⅢ~Ⅳ级比例、首次PS日龄、呼吸支持时间明显高于单次组(P<0.05),治疗前动脉血氧分压/吸入氧浓度(PaO_2/FiO_2)、治愈率均低于单次组(P<0.05),重复组伴有败血症、肺出血、休克、动脉导管未闭的比例高于单次组(P<0.05)。Logistic回归分析显示出生窒息(OR=5.674,95%CI 1.378~23.354)、首次PS日龄(OR=1.092,95%CI1.002~1.191)及合并动脉导管未闭(OR=23.499,95%CI 2.348~235.152)是足月儿和近足月儿RDS需重复使用PS治疗的独立危险因素。结论需重复使用PS治疗足月儿和近足月儿RDS的高危因素包括出生窒息、应用PS时间延迟及合并动脉导管未闭。
Objective To investigate the risk factors for the treatment of respiratory distress syndrome (RDS) in full-term and near-term infants with repeated application of pulmonary surfactant (PS). Methods The clinical data of full-term and near-term RDS pediatric patients treated with bovine pulmonary surfactant from January 2012 to December 2014 in our neonatal intensive care unit were retrospectively analyzed. According to the number of PS application, Repeated group, compared the two groups of children with general conditions, basic diseases, application of PS on the age and dose, parallel multivariate Logistic regression analysis. Results A total of 130 cases were enrolled, including 85 cases in the single group and 45 cases in the repeated group. The rate of repeated use of PS was 34.6%. In the repeat group, asphyxia, mothers’ gestational hypertension, pre-treatment X-ray film RDSⅢ-Ⅳ grade, first PS day and respiratory support time were significantly higher than those in the single group (P <0.05) / PaO2 / FiO2, the cure rate was lower than that of the single group (P <0.05). The proportion of repeat group with sepsis, pulmonary hemorrhage, shock and patent ductus arteriosus was higher than that of the single group (P <0.05) ). Logistic regression analysis showed asphyxia (OR = 5.674,95% CI 1.378-23.354), first PS day (OR = 1.092,95% CI 1.002-1.191) and patent ductus arteriosus (OR = 23.499,95% CI 2.348 ~ 235.152) is an independent risk factor for repeated treatment of PS with full-term and near-full-term RDS. CONCLUSIONS: The high risk factors for re-use of PS in term and full-term RDS include birth asphyxia, delayed PS time, and patent ductus arteriosus.