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題 名 | Risk Factors of Meconium Aspiration Syndrome Developing into Persistent Pulmonary Hypertension of Newborn=胎便吸入症候群發展成新生兒持續性肺高壓的危險因子 |
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作 者 | 謝德貴; 蘇百弘; 陳安琪; 林宗文; 蔡長海; 林鴻志; | 書刊名 | 臺灣兒科醫學會雜誌 |
卷 期 | 45:4 民93.07-08 |
頁 次 | 頁203-207+256 |
分類號 | 417.53 |
關鍵詞 | 胎便吸入症候群; 新生兒持續性肺動脈高壓; 窒息; 休克; Meconium aspiration syndrome; Persistent pulmonary hypertension of the newborn; Asphyxia; Pneumothorax; |
語 文 | 英文(English) |
中文摘要 | 臨床經驗顯示新生兒持續性肺高壓是胎便吸入症候群主要死亡原因,我們試著評估胎便吸入症候君發展爲新生兒持續性肺動脈高壓的危險因子,以期能降低胎便吸入症候群死亡率。自從1995~2003年,在本院進行一個回溯性的研究,分析包括胎兒心跳形態、生産方式、Apgar score、性別、懷孕週數、出生體重、院內出生或院外出生、到院前急救、住院1小時的動脈氣體分析和窒息、使用表面張力素、氣胸、肺出血、休克等在新生兒持續性肺高壓發生之前的危險因子,在9年間共362例有胎便吸入症候群,64例發生新生兒持續性肺高壓,298例沒有新生兒持續性肺高壓,雙變相分析顯示胎心跳形態改變(P<0.01)、院外出生(P=0.04)、酸血症(P=0.01)、窒息(P<0.001)、休克(P<0.001)、氣胸(P=0.02)、肺出血(P<0.001)是有意義的危險因子,回歸分析則顯示胎心跳改變、窒息和氣胸是最重要的危險因子。我們的結論是如何減少窒息的發生,將是減少PPHN和降低MAS死亡率的主要方法。 |
英文摘要 | Clinical experience indicates that persistent pulmonary hypertension of the newborn (PPHN) is one of the major causes of death in infants with meconium aspiration syndrome (MAS). We aimed to investigate the risk factors associated with MAS which lead to PPHN in order to search for ways to reduce the mortality associated with MAS. From 1995 to 2003, we conducted a retrospective study of infants with MAS at the China Medical University Hospital. We compared the risk factors associated with MAS, including pattern of fetal heart beat, mode of delivery, apgar score, sex, gestational age, birth body weight, in born or out born infants, resuscitation before admission, first pH at admission, asphyxia, surfactant usage, pneumothroax, pulmonary hemorrhage and shock before the diagnosis of PPHN between PPHN and non PPHN infants. During the nine-year study, 362 infants with IvL4S were enrolled. There were 64 infants with (17.7%) PPHN and 298 infants without PPHN. According to univariant analysis, the significant risk factors associated with MAS which lead to PPHN were out born infant (p=0.007). change of fetal heart beat pattern (p 0.0001). resuscitation before admission (p=0.0001), low pH (p 0.002), asphyxia (p<0.000J), shock (p<0.0001), pneumothorax (p=0.0004), and pulmonary hemorrhage (p<0.0002). Based on the results of logistic regression analysis, the risk factors were pneumothorax (p=0.04, odds ratio: 2.34), change of fetal heart beat pattern (p=0.02, odds ratio: 2.37) and asphyxia (p=0.001, odds ratio: 5.48). We conclude that pneumothorax, change of fetal heart beat pattern and asphyxia are the most important risk factors associated with MAS which lead to the development of PPHN. Avoidance of asphyxia and pneumothorax might be the key to reduce the incidence of PPNH and mortality rate of MA S. |
本系統中英文摘要資訊取自各篇刊載內容。