胎粪污染羊水新生儿发生重度胎粪吸入综合征的临床特征及预警因素分析

Clinical features of severe meconium aspiration syndrome (MAS) and early predicting factors for severe MAS in neonates with meconium-stained amniotic fluid

摘要:

目的 探讨胎粪污染羊水（meconium-stained amniotic fluid，MSAF）新生儿发生重度胎粪吸入综合征（meconium aspiration syndrome，MAS）的临床特征及预警因素。 方法 纳入2018年1月至2019年12月因Ⅲ°MSAF住院的新生儿295例为研究对象，按是否并发MAS分为无MAS组（n=199）、轻度/中度MAS组（n=77）和重度MAS组（n=19），回顾性收集3组患儿一般临床资料、血气分析结果、感染指标、母亲围生期临床资料等进行分析，并比较3组患儿出生后的呼吸支持方案。应用受试者工作特征曲线及多因素logistic回归分析MSAF新生儿发生重度MAS的预警因素。 结果 295例MSAF新生儿中32.5%（96/295）发生MAS，其中20%（19/96）为重度。重度MAS组出生5 min Apgar评分低于轻度/中度MAS组及无MAS组（P<0.05），脐动脉血乳酸水平高于轻度/中度MAS组和无MAS组（P<0.05），生后1 h外周血白细胞介素6（interleukin-6，IL-6）水平高于无MAS组（P<0.017）。重度MAS组患儿79%（15/19）出生无活力（其中13例行胎粪吸引术），100%在24 h内开始机械通气。生后1 h外周血IL-6水平>39.02 pg/mL及生后1 h白细胞计数>30.345×10⁹/L为MSAF新生儿发生重度MAS的预警指标（P<0.05）。 结论 胎粪吸引不能完全阻止MSAF新生儿严重MAS的发生；重度MAS患儿在出生早期即发生严重呼吸窘迫需要机械通气。监测脐动脉血乳酸及生后1 h外周血IL-6水平、白细胞计数有助于预警MAS的发生及严重程度。

Abstract:

Objective To study the clinical features of severe meconium aspiration syndrome (MAS) and early predicting factors for the development of severe MAS in neonates with meconium-stained amniotic fluid (MSAF). Methods A total of 295 neonates who were hospitalized due to Ⅲ° MSAF from January 2018 to December 2019 were enrolled as subjects. The neonates were classified to a non-MAS group (n=199), a mild/moderate MAS group (n=77), and a severe MAS group (n=19). A retrospective analysis was performed for general clinical data, blood gas parameters, infection indicators, and perinatal clinical data of the mother. The respiratory support regimens after birth were compared among the three groups. The receiver operating characteristic (ROC) curve and multivariate logistic regression analysis were used to investigate predicting factors for the development of severe MAS in neonates with MSAF. Results Among the 295 neonates with MSAF, 32.5% (96/295) experienced MAS, among whom 20% (19/96) had severe MAS. Compared with the mild/moderate MAS group and the non-MAS group, the severe MAS group had a significantly lower 5-minute Apgar score (P<0.05) and a significantly higher blood lactate level in the umbilical artery (P<0.05). Compared with the non-MAS group, the severe MAS group had a significantly higher level of interleukin-6 (IL-6) in peripheral blood at 1 hour after birth (P<0.017). In the severe MAS group, 79% (15/19) of the neonates were born inactive, among whom 13 underwent meconium suctioning, and 100% of the neonates started to receive mechanical ventilation within 24 hours. Peripheral blood IL-6 >39.02 pg/mL and white blood cell count (WBC) >30.345×109/L at 1 hour after birth were early predicting indicators for severe MAS in neonates with MSAF (P<0.05). Conclusions Meconium suctioning cannot completely prevent the onset of severe MAS in neonates with MSAF. The neonates with severe MAS may develop severe respiratory distress and require mechanical ventilation early after birth. Close monitoring of blood lactate in the umbilical artery and peripheral blood IL-6 and WBC at 1 hour after birth may help with early prediction of the development and severity of MAS.