新生儿呼吸窘迫:问题的现状

D. Ivanov, Y. Aleksandrovich, J. A. Temirova
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摘要

导言。新生儿呼吸窘迫是新生儿期并发症、中枢神经系统不可逆损伤和死亡的最常见原因之一。本研究旨在根据文献分析新生儿呼吸窘迫(RD)的流行病学、风险因素和结局的当前特征。分析包括2017年至2023年期间PubMed文摘数据库收录的112篇文献。检索时使用了关键词:呼吸窘迫、呼吸窘迫综合征、新生儿、有利结局、不利结局、风险因素、流行病学。在对摘要进行初步研究后,有 62 篇文章被排除在有关预测疾病结果和治疗措施对新生儿期呼吸衰竭病程影响的综述之外。有关新生儿呼吸窘迫流行病学的研究非常多,但其中的信息却极为不统一,无法推断世界各地新生儿重症监护室的患者。出生时体重过轻和妊娠期过短是新生儿期不良结局的主要风险因素,尤其是在发展中国家。体重极轻的早产儿是一个特殊的风险群体,尤其是当他们患有严重感染和败血症时。足月新生儿在新生儿期出现严重缺氧性呼吸衰竭,多数情况下表现为持续性肺动脉高压,需要耗费大量医疗资源。表面活性物质替代疗法和各种无创呼吸支持方案是显著降低 RD 新生儿死亡率的治疗策略。新生儿期低氧血症呼吸衰竭最常见的原因是新生儿呼吸窘迫综合征和一过性呼吸过速,这是由于足月新生儿的护理和手术分娩指征的增加造成的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Respiratory distress in newborns: current state of the problem
Introduction. Respiratory distress of newborns is one of the most common causes of complications, irreversible damage to the central nervous system and deaths in the neonatal period.The objective was to analyze the current features of epidemiology, risk factors and outcomes of respiratory distress (RD) in newborns according to the literature.Materials and methods. The analysis includes 112 publications included in the abstract PubMed database for the period from 2017 to 2023. The search was carried out using keywords: respiratory distress, respiratory distress syndrome, newborns, favorable outcome, unfavorable outcome, risk factor, epidemiology. After the initial study of abstracts, 62 articles were excluded from the review on predicting disease outcomes and the effect of therapeutic measures on the course of respiratory failure in the neonatal period.Results. Studies on the epidemiology of respiratory distress in newborns are very numerous, but the information available in them is extremely heterogeneous and cannot be extrapolated to patients with neonatal ICUs all over the world. Low weight and short gestation at the time of birth are the main risk factors for an unfavorable neonatal period outcome, especially in developing countries. A special risk group is prematurity with extremely low body weight, especially if they have severe infections and sepsis. Severe hypoxemic respiratory failure in the neonatal period in full-term newborns, in most cases, is noted in persistent pulmonary hypertension, which requires significant costs of all health care resources. Therapeutic strategies that have significantly reduced mortality in newborns with RD are surfactant replacement therapy and various options for non-invasive respiratory support.Conclusion. The most frequent cause of hypoxemic respiratory failure in the neonatal period is respiratory distress syndrome and transient tachypnea of newborns, which is due to nursing full-term newborns and increasing indications for surgical delivery.
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