重度胎粪吸入综合征并发急性呼吸窘迫综合征临床特征及转归分析

目的 探讨新生儿重度胎粪吸入综合征（meconium aspiration syndrome，MAS）并发急性呼吸窘迫综合征（acute?respiratory?distress syndrome，ARDS）的临床特征及转归，为临床诊治提供参考。 方法 回顾性收集2017年1月至2019年12月收治的60例重度MAS新生儿的临床资料，根据是否并发ARDS分为ARDS组（45例）与非ARDS组（15例），比较两组患儿的临床特征及转归。 结果 60例重度MAS患儿中，45例（75%）发生ARDS。ARDS组出生后1 h动脉血气分析显示中位氧合指数显著高于非ARDS组（4.7 vs 2.1，P<0.05）；两组间入院时白细胞计数、C-反应蛋白、白细胞介素-6水平及住院期间降钙素原、C-反应蛋白、白细胞介素-6的峰值水平比较差异无统计学意义（P>0.05）。ARDS组休克发生率高于非ARDS组（84% vs 47%，P<0.05），两组间持续性肺动脉高压、气胸、肺出血、缺氧缺血性脑病、颅内出血和弥漫性血管内凝血的发生率比较差异无统计学意义（P>0.05）。ARDS组较非ARDS组中位机械通气时间更长（53 h vs 3 h，P<0.05）。ARDS组治愈出院43例（96%），死亡2例（4%）；非ARDS组治愈出院15例（100%）。 结论 重度MAS并发ARDS患儿呼吸窘迫出现早，机械通气时间长，休克发生率更高；建议在管理重度MAS患儿过程中密切监测氧合指数，及时诊断及治疗ARDS，同时密切评估组织灌注，积极防治休克。 引用格式:

Clinical features and prognosis of severe meconium aspiration syndrome with acute respiratory distress syndrome

Objective To study the clinical features and prognosis of neonates with severe meconium aspiration syndrome (MAS) and acute respiratory distress syndrome (ARDS). Methods A retrospective analysis was performed on the medical data of 60 neonates with severe MAS who were admitted from January 2017 to December 2019. According to the presence or absence of ARDS, they were divided into two groups: ARDS (n=45) and non-ARDS (n=15). Clinical features and prognosis were compared between the two groups. Results Among the 60 neonates with severe MAS, 45 (75%) developed ARDS. Arterial blood gas analysis showed that the ARDS group had a significantly higher median oxygenation index within 1 hour after birth than the non-ARDS group (4.7 vs 2.1, P<0.05), while there was no significant difference between the two groups in white blood cell count, C-reactive protein (CRP), and interleukin-6 (IL-6) on admission and the peak values of procalcitonin, CRP, and IL-6 during hospitalization (P>0.05). The ARDS group had a significantly higher incidence rate of shock than the non-ARDS group (84% vs 47%, P<0.05). There was no significant difference between the two groups in the incidence rates of persistent pulmonary hypertension, pneumothorax, pulmonary hemorrhage, hypoxic-ischemic encephalopathy, intracranial hemorrhage, and disseminated intravascular coagulation (P>0.05). The ARDS group required a longer median duration of mechanical ventilation than the non-ARDS group (53 hours vs 3 hours, P<0.05). In the ARDS group, 43 neonates (96%) were cured and 2 neonates (4%) died. In the non-ARDS group, all 15 neonates (100%) were cured. Conclusions Neonates with severe MAS and ARDS tend to develop respiratory distress earlier, require a longer duration of mechanical ventilation, and have a higher incidence rate of shock. During the management of children with severe MAS, it is recommended to closely monitor oxygenation index, give timely diagnosis and treatment of ARDS, evaluate tissue perfusion, and actively prevent and treat shock. Citation: