【作者】 王娟；

【导师】 梅松丽；

【作者基本信息】 吉林大学 ， 公共卫生硕士（专业学位）， 2018， 硕士

【摘要】 目的:本研究调查早产儿呼吸窘综合征患儿及其母亲情况,探讨与早产儿呼吸窘综合征发生有关的各种相关高危因素,为早产儿呼吸窘综合征的积极预防、临床诊断和治疗提供科学的依据,同时降低并发症的发生概率,改善患儿预后,提高患儿生存质量,同时减轻患儿家庭经济负担以节约社会医疗资源。方法:选择2016年1月~2017年12月,在齐齐哈尔市某医院住院分娩的28周≤胎龄<37周的全部活产早产儿,收集患儿的性别、胎龄、出生体重及呼吸窘迫综合征发生情况、胎次、产次、是否多胎妊娠、颅内出血、肺出血、支气管肺发育不良、早产儿视网膜病、动脉导管未闭等情况,收集胎儿母亲的年龄、分娩方式、胎膜早破、前置胎盘、妊娠高血压、妊娠糖尿病等资料。本研究采用回顾性研究中的病例对照法,根据早产儿是否发生呼吸窘迫综合征将所有研究对象分为呼吸窘迫综合征组和非呼吸窘迫综合征组,两组间比较发生和未发生呼吸窘迫综合征的早产儿性别、胎龄、出生体重及呼吸窘迫综合征发生情况等一般资料,胎次、产次、是否多胎妊娠、分娩方式、母亲情况、胎膜早破、前置胎盘、妊娠高血压、妊娠糖尿病等围产期因素和颅内出血、肺出血、支气管肺发育不良、早产儿视网膜病、动脉导管未闭等并发症发生情况,采用岭回归方法分析影响住院分娩早产儿发生呼吸窘迫综合征的高危因素。结果:发生呼吸窘迫综合征与未发生呼吸窘迫综合征患儿的性别、母亲年龄比较,P>0.05,无统计学差异。发生呼吸窘迫综合征与未发生呼吸窘迫综合征患儿的胎龄、出生体重、胎龄分周、胎次、产次、是否多胎妊娠、母亲职业、母亲学历比较,P<0.05,具有统计学差异。发生呼吸窘迫综合征与未发生呼吸窘迫综合征患儿的分娩方式、窒息史、吸入史、脐带绕颈、羊水清否、羊水量、胎膜早破、宫内窘迫、前置胎盘、胎盘早剥、妊娠高血压、妊娠糖尿病、颅内出血、肺出血、支气管肺发育不良、动脉导管未闭、新生儿感染、持续性肺动脉高压和是否使用呼吸机比较,P<0.05,具有统计学差异。自变量存在多重共线性,采用岭回归检验,F=5.247,P=0.001,提示回归模型拟合较好,结果表明出生体重、胎次、多胎、分娩方式、窒息史、吸入史、脐带、羊水清否、羊水多少、母亲年龄、胎膜早破、宫内窘迫、前置胎盘、胎盘早剥、妊娠高血压、妊娠糖尿病、颅内出血、肺出血、支气管肺发育不良、动脉导管未闭、新生儿感染、持续性肺动脉高压、呼吸机的使用与住院分娩早产儿呼吸窘迫综合征发生相关。结论:此次研究调查了齐齐哈尔市某医院415例早产儿,其中呼吸窘迫综合征116例,占27.95%。发现早产儿呼吸窘迫综合征的发生情况与胎龄、出生体重、孕产妇的一般资料,胎次、产次、是否多胎妊娠、分娩方式、母亲情况、胎膜早破、前置胎盘、妊娠高血压、妊娠糖尿病等围产期因素和颅内出血、肺出血、支气管肺发育不良、动脉导管未闭等情况有关。更多还原

【Abstract】 Objective:To investigate the situation of neonatal respiratory distress syndrome(NRDS)patients and their mothers,analyzes the risk factors that may lead to the occurrence of NRDS clinically,and explores various high risk factors related to the occurrence of NRDS,so as to provide active prevention,clinical diagnosis and treatment of NRDS.To provide a scientific basis,while reducing the probability of complications,improve the prognosis of children,improve the quality of life of children,while reducing the economic burden of children’s families to save social medical resources.Methods:All live births of premature infants whose gestational age was less than 37 weeks were delivered in a hospital of Qiqihar City from January 2016 to December 2017.The general data,such as sex,gestational age,birth weight and incidence of respiratory distress syndrome,parity,multiple pregnancy,mode of delivery,maternal condition,premature rupture of membranes,and so on were collected.Perinatal factors such as placenta previa,gestational hypertension,gestational diabetes mellitus and complications such as intracranial hemorrhage,pulmonary hemorrhage,bronchopulmonary dysplasia,retinopathy of premature infants,patent ductus arteriosus and so on.A retrospective case-control study was conducted to divide all the subjects into respiratory distress syndrome group and non-respiratory distress syndrome group according to whether or not respiratory distress syndrome occurs in premature infants.The sex,gestational age,birth weight and respiratory distress of premature infants with and without respiratory distress syndrome were compared between the two groups.General information on the occurrence of syndromes,such as parity,parity,multiple pregnancy,mode of delivery,mother’s condition,premature rupture of membranes,placenta previa,pregnancy-induced hypertension,gestational diabetes mellitus andintracranial hemorrhage,pulmonary hemorrhage,bronchopulmonary dysplasia,retinopathy of premature infants,patent ductus arteriosus,etc.Ridge regression analysis was used to analyze the high risk factors of respiratory distress syndrome in hospitalized premature infants.Results:There was no significant difference in sex and age between children with and without respiratory distress syndrome(P > 0.05).The difference of the gestational age,birth weight,gestational age,births,parity,multiple births,mother’s occupation and mother’s educational background of children with respiratory distress syndrome and those without respiratory distress syndrome was statistically significant(P <0.05).There was no significant difference of sex and age of mother of the children with and without respiratory distress syndrome(P> 0.05)between the two groups.The different of amniotic fluid clearance,amniotic fluid volume,premature rupture of membranes,intrauterine distress,placenta previa,placental abruption,gestational hypertension,gestational diabetes mellitus,intracranial hemorrhage,pulmonary hemorrhage,bronchopulmonary dysplasia,patent ductus arteriosus,neonatal infection,persistent pulmonary hypertension and the use of ventilators were statistically significant(P < 0.05).Multiple collinearity existed in the strain,F=5.247,P= 0.001 by ridge regression test,suggesting that the regression model fitted well,including birth weight,parity,multiple births,mode of delivery,history of asphyxia,inhalation,umbilical cord,amniotic fluid clearance,amniotic fluid,maternal age,premature rupture of membranes,intrauterine distress,placenta previa,placental abruption,pregnancy.Pregnant hypertension,gestational diabetes mellitus,intracranial hemorrhage,pulmonary hemorrhage,bronchopulmonary dysplasia,patent ductus arteriosus,neonatal infection,persistent pulmonary hypertension,ventilator were associated with the occurrence of respiratory distress syndrome in hospitalized premature infants.Conclusion:415 premature infants in a hospital in Qiqihar City were investigated and 116 cases of respiratory distress syndrome(27.95%).It shows that the sex,gestational age,birth weight and the incidence of respiratory distress syndrome in premature infantswith and without respiratory distress syndrome,and other general information,parity,parity,multiple pregnancy,mode of delivery,maternal status,fetal age Premature rupture of membranes,placenta previa,gestational hypertension,gestational diabetes and other perinatal factors and intracranial hemorrhage,pulmonary hemorrhage,bronchopulmonary dysplasia,retinopathy of premature infants,patent ductus arteriosus complications.更多还原