摘要：
Objective To investigate the high risk factors of persistent pulmonary hypertension (PPHN) in preterm and full-term neonates.Methods Fifty-six newborns with PPHN were divided into preterm neonates group and the full-term neonates group according to their gestational ages.The relationship between PPHN and high risk factors such as the primary diseases,mother's complications during pregnancy,and the prognosis were analyzed retrospectively in each group.A retrospective review of lung samples of 3 neonates who died of respiratory failure were carried out.Results Thirty-one (55.36％) out of 56 neonates with PPHN including 27 preterm and 29 full-term newborns had parenchyma diseases.The first and the second primary diseases were meconium aspiration syndrome (MAS,9/29 cases,31.03％) and congenital heart diseases (8/29 cases,27.59％) in the full-term group,and respiratory distress syndrome (RDS,16/27 cases,59.26％) and infection (8/27 cases,29.63％) in preterm group,respectively.There were 15 cases (55.56％) whose mothers had complications during pregnancy among the 27 preterm neonates,and 8 ca ses (27.59％) among the 29 full-term neonates.The morbidity of mothers' complications during pregnancy in preterm neonates was higher than that in full-term neonates (x2 =4.519,P =0.034).The mortality rate was 33.33％ (9/27cases) in the preterm neonates group while 27.59％ (8/29 cases) in the full-term neonates group.There was no significant difference in mortality rate between each group (x2 =0.218,P =0.640).The primary diseases were RDS (9/9cases,100％) and MAS (4/8 cases,50％) in preterm and full-term neonates who died of PPHN,respectively.One case of pulmonary hypertensive vascular remodeling,1 case of alveolar capillary dysplasia (ACD) and 1 case of interstitial pneumonia were found in 3 lung samples of neonates died of PPHN.Conclusions The ratio of preterm increased in neonates with PPHN.RDS and infection were the first two primary diseases in preterm neonates with PPHN.MAS was the first primary disease in full-term neonates with PPHN.Primary pulmonary hypertension should be considered for neonates with severe PPHN.%目的 探讨新生早产儿和足月儿持续肺动脉高压(PPHN)发病的高危因素.方法 收集56例PPHN新生儿资料,分为早产儿组和足月儿组,回顾性分析2组原发疾病、母亲妊娠期并发症与PPHN的关系及其不同转归.3例死亡患儿行尸体解剖、肺部病理学检查.结果 PPHN患儿足月儿29例,早产儿27例.原发于肺部病变者31例(31/56例,55.36％),足月儿原发病首位及第2位分别为胎粪吸入综合征(MAS,9/29例,31.03％)和先天性心脏病(8/29例,27.59％),早产儿分别为新生儿呼吸窘迫综合征(RDS,16/27例,59.26％)和感染(8/27例,29.63％).早产儿母亲患妊娠期疾病者占55.56％(15/27例),足月儿母亲妊娠期疾病者占27.59％(8/29例).早产儿和足月儿2组母亲有妊娠期并发症者比较差异有统计学意义(X2=4.519,P=0.034).早产儿未愈率33.33％(9/27例),原发病均为RDS(100％,9/9例);足月儿未愈率27.59％(8/29例),其中原发病为MAS者占50％(4/8例).2组未愈率比较差异无统计学意义(x2=0.218,P=0.640).3例死亡患儿肺部病理学检查发现,肺泡毛细血管发育不良1例,高血压性肺血管重塑1例,间质性肺炎改变1例.结论 早产儿在PPHN患儿中比例升高,RDS和感染为早产儿PPHN最常见原因.MAS是足月儿发生PPHN的首位原因.对严重PPHN的新生儿,原发性肺动脉高压需得到重视.
