早期输液量对晚期早产儿重症湿肺预后的影响

徐晓妮 王亚萍 王卫华 张苏红

[摘要] 目的 探討早期输液量对晚期早产儿重症湿肺预后的影响情况。 方法 回顾性分析2013年10月～2015年10月陕西省咸阳市第一人民医院儿科136例早产儿重症湿肺患儿的临床资料，依据输液量不同进行分组：A组66例，输液量为<60 mL/（kg·d）；B组70例，输液量为≥60 mL/（kg·d）。观察两组患儿输液前后透光度减低或叶间积液加重比例、呼吸支持时间中位数情况；比较两组患儿住院时间、平均每小时尿量、患儿家属满意度、并发症发生率。 结果 输液前两组患儿透光度减低或叶间积液加重比例、呼吸支持时间中位数比较，差异均无统计学意义（χ2 = 0.37，t = 0.51，均P > 0.05）。输液后A组患儿透光度减低或叶间积液加重比例（9.1%）低于输液前（50.0%），呼吸支持时间[（73.8±10.9）h]高于输液前[（51.5±9.4）h]，差异均有统计学意义（χ2 = 40.18、t = 12.59，均P < 0.05）。输液后B组患儿透光度减低或叶间积液加重比例（37.1%）低于输液前（54.3%），呼吸支持时间[（62.8±9.4）h]高于输液前[（52.3±8.9）h]，差异均有统计学意义（χ2 = 5.96、t = 6.79，均P < 0.05）。输液后B组患儿透光度减低或叶间积液加重比例高于A组，患儿呼吸支持时间中位数低于A组，差异均有统计学意义（χ2 = 22.07、t = 6.31，均P < 0.05）；A组和B组患儿平均每小时尿量比较，差异无统计学意义[（2.5±0.3）比（2.6±0.4）mL，t = 1.64， P > 0.05]。A组和B组患儿家属满意度比较，差异无统计学意义（95.5%比94.3%，χ2 = 0.15，P > 0.05），B组患儿住院时间长于A组[（15.6±6.5）比（9.5±4.0）d]，并发症发生率均高于A组（77.1%比39.4%），差异均有统计学意义（t = 6.54、χ2 = 29.22，均P < 0.05）。 结论 适当的早期输液量对于晚期早产儿重症湿肺预后具有重要的意义，过多的输液量可能增加并发症的发生。

[关键词] 早期输液量；晚期早产儿；重症湿肺；预后；影响

[中图分类号] R722.6 [文献标识码] A [文章编号] 1673-7210（2016）02（c）-0123-04

Influence of early infusion quantity on prognosis of late preterm with servious wet lung

XU Xiaoni WANG Yaping WANG Weihua ZHANG Suhong

Department of Neonatology， the First People's Hospital of Xianyang City， Shaanxi Province， Xianyang 712000， China

[Abstract] Objective To approach influence of early infusion quantity on prognosis of late preterm with serious wet lung. Methods Clinical data of 136 late preterm with serious wet lung from October 2013 to October 2015 in Department of Pediatrics of the First People's Hospital of Xianyang City were retrospectively analyzed， and they were divided into two groups according different infusion quantity： 66 cases of group A， infusion quantity < 60 mL/（kg·d）； 70 cases of group B， infusion quantity≥60 mL/（kg·d）. Proportion of light transmittance reducing or effusion aggravating， median of respiratory support time of children in two groups before and after infusion were observed； length of hospital stay， average urine volume per hour and satisfaction of children's families， incidence of complications of children in two groups were compared. Results The ratio of light transmittance reducing or effusion aggravating， median of respiratory support time of two groups before infusion had no statistically significant differences （χ2 = 0.37， t = 0.51， all P > 0.05）. The ratio of light transmittance reducing or effusion aggravating of group A after infusion （9.1%） were lower than before infusion （50.0%）， respiratory support time [（73.8±10.9） h] was higher than before infusion [（51.5±9.4） h]， the differences were statistically significant （χ2 = 40.18， t = 12.59， all P < 0.05）； the ratio of light transmittance reducing or effusion aggravating of group B after transfusion （37.1%） was lower than before infusion（54.3%）， respiratory support time [（62.8±9.4） h] was higher than before infusion [（52.3±8.9） h]， the differences were statistically significant （χ2 = 5.96， t = 6.79， all P < 0.05）. The ratio of light transmittance reducing or effusion aggravating of group B after infusion was higher than group A， median respiratory support time of group B was lower than group A， the differences were statistically significant （χ2 = 22.07， t = 6.31， all P < 0.05）. The average urine volume per hour of group A and Group B had no statistically significant difference [（2.5±0.3） vs （2.6±0.4） mL， t = 1.64， P > 0.05]， satisfaction of children's families of group A and group B had no statistically significant difference （95.5% vs 94.3%， χ2 = 0.15， P > 0.05）； length of hospital stay of group B was higher than that of the group A [（15.6±6.5） vs （9.5±4.0） d]， incidence of complications of children of group B was longer than group A （77.1% vs 39.4%）， the differences were statistically significant （t = 6.54， χ2 = 29.22， all P < 0.05）. Conclusion Appropriating early infusion quantity have important significance for late preterm with serious wet lung， too much infusion quantity can increase incidence of complications.

[Key words] Early infusion quantity； Late preterm； Servious wet lung； Prognosis； Influence

新生儿湿肺又被称为新生儿暂时性呼吸困难或Ⅱ型呼吸窘迫综合征，患儿肺内液体清除延迟，发生积聚，从而诱发呼吸急促，严重者可能出现呼吸困难和呼吸性酸中毒，甚至可能发生呼吸衰竭，诱发死亡[1-2]。研究资料显示[3-4]，早产儿发生湿肺的比例较高，其中有近3/4为晚期早产儿，晚期早产儿发生重症湿肺，起病较早，病情较重，进展较快，呼吸支持依赖程度较高，需要有效的监护、呼吸支持和合理的输液量进行对症治疗。本研究通过对陕西省咸阳市第一人民医院（以下简称“我院”）湿肺患儿的临床资料进行分析，拟探讨早期输液量对晚期早产儿重症湿肺预后的影响情况，现将结果报道如下：

1 资料与方法

1.1 一般资料

选取2013年10月～2015年10月于我院儿科住院治疗的136例早产儿重症湿肺患儿的临床资料进行分析，早产儿重症湿肺诊断标准参照《实用新生儿学》中的诊断标准[5-6]。依据……