新生儿肺出血的病因分析VIP免费

基金项目:广州市计划委员会资助项目(穗科技[1998]11号)作者单位:510120广州市儿童医院新生儿科·论著·新生儿肺出血的病因分析陈克正张喆【摘要】目的探讨新生儿肺出血病因。方法选择1958年5月至2004年4月46年期间,我院新生儿肺出血死亡病例788例,将肺出血按不同病理表现分为点状肺出血、局灶性肺出血及弥漫性肺出血,以此进行临床与病理诊断资料统计,并结合发病机制做进一步分析、明确肺出血病因。结果本组每例肺出血患儿均有多种疾病共存,临床与病理诊断不完全相符,但两者所涉及的疾病诊断内容基本一致,共归类出“缺氧因素”、“感染因素”及“其他因素”3大类21种病变。再根据肺出血发病机制将16项肺出血病因分为“缺氧因素”共10项388例(49124%),以寒冷损伤及吸入性肺炎为多;“感染因素”共6项400例(50176%),以感染性肺炎为多。在归类为“其他因素”共5项中,包括最常见的早产,均合并有缺氧或感染,无1例因单纯早产而导致肺出血者。结论结合上述3类因素,认为可明确证实的病因有寒冷损伤、围产期缺氧及严重感染。须进一步探讨的病因有机械通气不当、外源性肺表面活性物质应用、氧中毒、孕母患妊娠期高血压疾病。可排除为肺出血的病因有早产、急性心力衰竭、高黏滞血症或红细胞增多症、弥漫性血管内凝血及核黄疸。【关键词】肺疾病;出血;婴儿,新生PathogenesisofneonatalPulmonaryhemorrhageCHENKe2zheng,ZHANGZhe1DepartmentofNeo2natology,GuangzhouChildren’sHospital,Guangzhou510120,China【Abstract】ObjectiveToinvestigatethecausalagentsofneonatalpulmonaryhemorrhage(NPH).MethodsSelected788autopsiedcasesdiedfromNPHsinceMay,1958toApril,20041ThepathologicfeaturesofNPHweredividedinto3types:petechialpulmonaryhemorrhage,focalpulmonaryhemorrhageanddiffusepulmonaryhemorrhage1ThecausalagentsofNPHwereanelyzedpathologicallyandchnically1ResultsEachcaseofNPHhadcomplicatedotherdifferentdisease,sothatthereweresomeincompletecoincidencesbetweenclinicandpathologicdiagnosis,butthecontentsofdiagnosisbothinclinicandpathologicdiagnosiswerecoincidedbasically1Therewere21kindsofdiagnosissurveyed1Accordingtothepathogenesis,thecausalagentsweredividedinto3majorcausalfactors:hypoxia,infec2tionandothers1AsthecausalagentofNPH,hypoxiaincluded10itemstotal388cases(49124%),coldinjureandaspirationpneumoniawerethemostcommonincidencesinthisgroup1Therewere6itemstotal400cases(50176%)ininfectiousgroup1Thechiefdiseasewasinfectiouspneumonia1Otherfactorsgroupincluded5,itemsthemostimportantcausewasprematuredelivery,allofthemdiedfromhypoxiaorinfectionbutnotonlyfromNPH1ConclusionsAmongthemanycausalagentsofthedeathinNPH,theclearcausalagentsarecoldinjure,hypoxiaandseriousinfection1Thepossiblecausalagentsarein2correctmechanicalventilation,exogenouspulmonarysurfactantreplacement,oxygenintoxication,hyper2tensivedisordercomplicatingpregnancy1Thefollowingcausalfactorscouldbeexcepted:prematuredeliv2ery,acuteheartfailure,polycythemiaorhyperviscositysyndrome1Disseminatedintravascularcoagula2tionsandnuclearjaundice1【Keywords】Lungdiseases;Hemorrhage;Infant,newborn·3·中国新生儿科杂志2008年第23卷第1期1995年以前,我国新生儿肺出血发生率及病死率均较高,此期间探讨新生儿肺出血病因的文章亦较多,提及的病因有10多项,以围生期缺氧、寒冷损伤、早产、严重感染为多见[1],其余病因报道文献不多,例数较少,且多以临床原发病诊断为依据去推断。由于新生儿各系统发育不成熟,一例患儿常有多种疾病并存,临床诊断亦常与病理诊断不完全相符,相信过去的肺出血病因分析会有偏差。近年来开展的肺出血发病机制研究,可为重新探讨肺出血病因提供依据,为此对我院新生儿肺出血死亡病例进行统计分析,以便明确肺出血病因。资料和方法一、资料来源1958年5月至2004年4月的46年期间,我院新生儿死亡病理检查共1...