目的 观察非医学指征择期剖宫产足月新生儿呼吸窘迫综合征(RDS)的临床特点.方法 选择2013年5月至2015年12月在扬州大学医学院附属淮安市妇幼保健院新生儿医学中心住院的非医学指征择期剖宫产足月新生儿94例,根据是否发生RDS分为RDS组(33例)和非RDS组(61例).观察和比较2组间相关临床指标的变化.结果 非医学指征择期剖宫产足月新生儿的RDS的构成比为35%,其中急性呼吸窘迫综合征占67%,其诊断和处理时间为生后12~24 h.2组患儿在性别、胎次、胎龄、Apgar评分、入院时日龄、住院天数、住新生儿重症监护病房(NICU)天数的比较差异均无统计学意义(P>0.05);RDS组患儿出生体质量和动脉氧气分压/吸入氧气体积分数(P/F)值均低于非RDS组患儿,差异均有统计学意义(P均<0.05);RDS组患儿Downs评分、住院总费用、住院天数和住NICU天数均高于非RDS组,差异均有统计学意义(P均<0.05).2组患儿在新生儿窒息发生率、气漏发生率、低血糖症发生率、重度ICH的发生率和CPAP治疗有效率的比较,差异均无统计学意义(P均>0.05).RDS组患儿的CPAP治疗失败率、气管插管比率、机械通气时间和吸入氧浓度>60%比率均高于非RDS组患儿,差异均有统计学意义(P均<0.05).RDS组患儿合并早发型败血症(EOS)和持续肺动脉高压(PPHN)的发生率均高于非RDS组患儿,差异均有统计学意义(P均<0.05).RDS组患儿合并ICH的发生率低于非RDS组患儿,差异有统计学意义(P<0.05).结论 非医学指征择期剖宫产足月新生儿RDS的发生率较高、病情较严重且并发症多,其发病可能与ECD相关.降低非医学指征择期剖宫产率、早期发现和积极处理足月新生儿RDS对降低新生儿病死率具有重要的临床意义.%Objective To observe clinical features of full term neonates with respiratory distress syndrome treated by elective cesarean delivery (ECD) with non medical indications.Methods From May 2013 to December 2015, 94 full term neonates with non medical indications for ECD were enrolled form Neonatal Medical Center of Maternal and Child Health Hospital of Huai''an.All full term neonates were divided into RDS group and non RDS group depending on whether met the diagnostic standard of RDS.The changes of clinical indications between the two groups were observed and compared.Results The constituent ratio of full term neonates with RDS undergoing ECD with non medical indications was 35%, in which the acute respiratory distress syndrome(ARDS) was 67%, Its diagnosis and treatment time were among 12-24 hours after birth.There were no statistical significance on the gender, parity, gestational age, Apgar score, hospitalization time, hospitalization days and length of stay in NICU between the two groups (all P>0.05);The birth weight and arterial oxygen pressure/aspiratory oxygen volume fraction(P/F) in the RDS group were lower than those in the non RDS group, and the difference were statistically significant (all P<0.05);The Downs score, total hospital costs, hospitalization days and length of stay in NICU in the RDS group were higher than those in the non RDS group, and the difference were statistically significant (all P<0.05);There were no statistical significance on the incidence of neonatal asphyxia, gas leakage, hypoglycemia, severe ICH and CPAP treatment rate between the two groups (all P>0.05);The CPAP treatment failure rate, tracheal intubation rate, mechanical ventilation time and the ratio of aspired oxygen concentration>60% in the RDS group were higher than those in the non RDS group, and the difference were statistically significant (all P<0.05);The incidence of early onset sepsis (EOS) and persistent pulmonary hypertension (PPHN) in the RDS group were higher than those in the non RDS group, and the difference were statistically significant (both P<0.05);The incidence of ICH in the RDS group was lower than that in the non RDS group, and the difference was statistically significant (P<0.05).Conclusion The incidence of RDS in full term neonates with non medical indications for ECS is higher, and the disease is more serious and more complicated.It might be related to the incidence of EOS.Decreasing the rate of ECS with non medical indications, early detecting and treating of full term neonates with RDS have important clinical significance for reducing neonatal mortality.
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