Related factors and preventive measures of neonatal persistent pulmonary hypertension after resuscitation for neonatal asphyxia
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摘要:目的 分析新生儿窒息复苏后发生持续性肺动脉高压(PPHN)的相关因素及预防措施。方法 选取50例新生儿窒息患儿，将动脉导管前(右桡动脉)与动脉导管后(左桡动脉)的血氧分压[p(O2)]差值>15 mmHg者设为肺动脉高压组，共16例; p(O2)差值≤15 mmHg者设为非肺动脉高压组，共34例。非肺动脉高压组中p(O2)差值为5~15 mmHg的20例患儿又分为常规治疗组10例与干预组10例。分析新生儿窒息复苏后发生新生儿持续性肺动脉高压的相关因素，比较常规组与干预组的总有效率。结果 日龄、出生体质量、血糖、血压、体温、复苏抢救方式和血气pH值是新生儿窒息复苏后发生新生儿持续性肺动脉高压的影响因素(P < 0.05)。干预组患儿治疗总有效率显著高于常规组(P < 0.05)。结论 新生儿窒息复苏后发生新生儿持续性肺动脉高压的相关因素较多，包括日龄、出生体质量、血糖、血压、体温、平均血气pH值、复苏抢救方式等。根据PPHN的相关因素，给予患儿针对性的预防措施，可有效降低PPHN的发生率。Abstract:Objective To analyze the related factors and preventive measures of neonatal persistent pulmonary hypertension (PPHN) after resuscitation for neonatal asphyxia.Methods Totally 50 neonates with neonatal asphyxia were selected and divided into two groups. Pulmonary hypertension group included 16 cases with the difference of partial pressure of oxygen[p(O2)] between anterior (right radial artery) and posterior (left radial artery) over 15 mmHg, and non-pulmonary hypertension group included 34 cases with the difference of p(O2) less than or equal to 15 mmHg. The 20 cases with p(O2) difference from 5 to 15 mmHg in non-pulmonary hypertension group were randomly divided into conventional treatment group (n=10) and intervention group (n=10). Related factors of neonatal persistent pulmonary hypertension after resuscitation for neonatal asphyxia were analyzed, and the total effective rate between conventional group and intervention group was compared.Results Age, birth weight, blood sugar, blood pressure, body temperature, resuscitation rescue methods and pH value of blood gas were the influencing factors of neonatal persistent pulmonary hypertension after resuscitation for asphyxia (P < 0.05). The total effective rate of intervention group was significantly higher than that of conventional group (P < 0.05).Conclusion There are many factors related to neonatal persistent pulmonary hypertension after resuscitation for neonatal asphyxia, including age, birth weight, blood sugar, blood pressure, body temperature, average pH value of blood gas, resuscitation and rescue methods. According to the related factors of PPHN, the incidence rate of PPHN can be effectively reduced by giving specific preventive measures to children with PPHN.
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表 1 新生儿窒息复苏后发生PPHN的单因素分析(x±s)[n(%)]
因素 肺动脉高压组(n=16) 非肺动脉高压组(n=34) 性别 男 9(56.25) 18(52.94) 女 7(43.75) 16(47.06) 日龄 < 5 d 15(93.75)* 19(55.88) ≥5 d 1(6.25)* 15(44.12) 低血压 是 12(75.00)* 9(26.47) 否 4(25.00)* 25(73.53) 低血糖 是 12(75.00)* 14(41.18) 否 4(25.00)* 20(58.82) 低体温 是 10(62.50)* 7(20.59) 否 6(37.50)* 27(79.41) 复苏抢救方式 鼻导管吸氧 2(12.50)* 21(61.76) 气囊加压给氧 14(87.50)* 13(38.24) 平均出生体质量/g 2 614.39±10.24* 2 621.46±10.27 平均血气pH值 6.92±0.27* 7.05±0.32 与非肺动脉高压组比较, *P < 0.05。 
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表 2 干预组与常规组患儿预防治疗措施的总有效率比较[n(%)]
组别 n 十分有效 有效 无效 总有效 干预组 10 6(60.00) 3(30.00) 1(10.00) 9(90.00)* 常规组 10 2(20.0) 4(40.00) 4(40.00) 6(60.00) 与常规组比较, *P < 0.05。
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