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第一部分呼吸窘迫综合征早产儿宫外发育迟缓的临床观察中文摘要目的评价患有新生儿呼吸窘迫综合征(respiratory distress syndrome,RDS)的早产儿出生时宫内发育迟缓(intrauterine growth retardation,IUGR)和出院时宫外生长发育迟缓(extrauterine growth retardation,EUGR)的发生率并分析早期营养对其的影响。方法收集新生儿重症监护室符合入选标准的70例RDS患儿的临床资料,根据出院时体质量有无存在EUGR,分为EUGR组和非EUGR组,应用SPSSl 70统计软件进行数据分析,比较两组基本情况、围产期因素、住院期间营养摄入状况、治疗措施及合并症方面的差异。结果 以体质量评价,70例RDS患儿IUGR与EUGR发生率分别为1429(1070)和6000(4270);EUGR组与对照组出生体质量、出生头围、IUGR、多胎妊娠、分娩方式差异有统计学意义(P005)。结论RDS患儿的EUGR与存在IUGR、多胎妊娠、剖宫产、出生体质量低、出生头围小有关,住院短时间的营养干预尚不能改善RDS患儿的宫外发育迟缓。研究生:崔风静(儿科学)指导教师:单若冰教授关键词:新生儿呼吸窘迫综合征;宫外发育迟缓;早期营养;婴儿,早产J|III I I lU II I I II III I IIlY2338748第二部分 呼吸窘迫综合症早产儿宫外发育迟缓的危险因素分析中文摘要目的探讨新生儿呼吸窘迫综合征(respiratory distress syndrome,RDS)早产儿宫外发育迟缓(extrauterine growth retardation,EUGR)的发生情况,并分析其相关危险因素,探讨预防对策,降低其发生率,改善营养状况。方法收集2011年1月1日2012年10月31日NICU的60例适于胎龄儿的RDS早产儿的临床资料,根据出院时体质量与矫正胎龄的关系,分为EUGR组与非EUGR组,应用SPSSl70软件进行数据分析,比较两组基本情况、围产期因素、营养摄入情况、治疗措施及并发症方面的差异;并对相关因素进行Logistc回归分析,筛选出RDS早产儿宫外发育迟缓的高危因素。结果RDS早产儿中适于胎龄儿的宫外发育迟缓发生率为5667(3460)。EUGR组与非EUGR组出生体质量、最小体质量、多胎妊娠、分娩方式差异有统计学意义(PO05)。Logistc回归分析:恢复出生体重时间、多胎妊娠为危险因素,产前激素应用为保护性因素。结论RDS早产儿中适于胎龄儿的EUGR与多胎妊娠、剖宫产、出生体质量低、最小体质量有关,恢复出生体重时间及多胎妊娠为EUGR危险因素。研究生:崔凤静(儿科学)指导教师:单若冰教授关键词:新生儿呼吸窘迫综合症;宫外发育迟缓;危险因素;婴儿,早产First Part Clinical Observation of extrauterine growth retardation ininfants with respiratory distress syndromeAbstractobjective To assess the incidences of intrauterine growth etardation(IUGRl and extrauterine growthretardation(EUGR)in premature infants with respiratory distress syndrome(RDS)and early nutritionaleffency on EUGRMethods Data of 70 infants with RDS incharged in neonatal intensive care unit werereviewedAccording to the weight when he(she)is discharged,all subjects were divided into EUGRgroup and nonEUGR groupThe SPSS 1 70 was applied to analyze the dataThe difference of 2groups in terms of basic situation,matemity pathological conditions,nutritional support,treatmentmeasures and complications were comparedResults Assessing by weight,the incidence ofIUGR and EUGR was respectively 1429(1070)and6000(4270)The differences in birth weight,head circumference at birth、intrauterine growthetardation were considered statistically significant(PO05)Conclusion The extrauterine growth retardation is a complex outcome of multiple factor interaction,intrauterine growth etardation,multiple pregnancy,cesarean delivery,low birth weight,low birth headcircumference is subject to extrauterine growth retardationCurrent nutrition support should advanceto prevent extrauterine growth retardation in RDSPostgraduates students:Feng-Jing Cui(Pediatrics)Directed by ProfiRuo-Bing ShanKey words:Respiratory Distress Syndrome,Extrauterine GrowthRetardation,Early Nutrition;Premature InfantSecond Part Analysis of Risk Factors for Extrauterine GrowthRetardation in Infants with Respiratory Distress SyndromeAbstractobjective To explore the epidemiological rule and correlated risk factors of extrauterine growthretar-dation in prematue infants with respiratory distress syndrome and to provide prevention andreduce its morbidityMethods Data of 60 infants with RDS who were appropriate for gestationage incharged fromJan120 1 1 to Oct3020 1 2 at the Neonatal Intensive Care Unit of Qingdao Women and ChildrenHospital were reviewedAccording to the weight when he(she)is discharged,all subjects were dividedinto EUGR group and nonEUGR groupThe SPSS 170 was applied to analyze the dataThe differenceof 2 groups in terms of basic situation,peripartum factors,nutrifional support,treatment measures andcomplications were comparedCorrelation factors were screened out by Logistc regression analysisResults Among 60 RDSs who were appropriate for gestationage,34 cases were extrauterine growthretardationThe differentces in birth weight,the minimum weight,multiple pregnancy,delivery patternwere considered statistically significant(P005)Logistcregression analysis:The time to regain birth weight and multiple pregnancy were independent riskfactors for extrauterine growth retardation,while prenatal use of cortical hormone was its protectivefactorConclusions The extrauterine growth retardation in RDSs who were appropriate for gestation age isrelated谢m low birth weight,multiple pregnancy,cesarean deliveryThe time to regain birth weightand multiple pregnancy were independent risk factors for extrauterine growth retardation in RDSPostgraduates students:Feng-Jing Cui(Pediatrics)Directed by ProfRuo-Bing ShanKey words:Respiratory Distress Syndrome,Extrauterine Growth Retardation,Early Nutrition:Premature InfantRDSIUGREUGRPSNICUCPAPCMVHFOVENPNPDAPVLIVHNECPPHNBPD常用儿科专有名词英文缩写respiratory distress syndrome新生儿呼吸窘迫综合征intrauterine growth retardation宫内发育迟缓extrauterine growth retardation宫外生长发育迟缓pulmonary surfactant肺表面活性物质neonatal intensive care unit新生儿重症监护室continuous positive airway pressure持续气道正压呼吸conventional mechanical ventilation常频机械通气high-frequency oscillatory ventilation高频通气enteral nutrition肠内营养parenteral nutrition肠外营养pantent duct-us arteriosus动脉导管未闭periventricular-intraventricular hemorrhage脑室周脑室内出血necrotizing enterocolitis新生儿坏死性小肠结肠炎persistent pulmonary hypertension新生儿持续性肺动脉高压bronchopulmonary dysplasia支气管肺发育不良目录第一部分呼吸窘迫综合征的早产儿宫外发育迟缓的临床观察。1引言1第一章研究对象及方法211 研究对象212 研究方法213 观察项目314 统计方法4第二章结果521基本资料比较522围产期因素、营养支持、呼吸支持级并发症的比较6第三章 讨论11结仑13参考文献14第二部分呼吸窘迫综合症早产儿宫外发育迟缓的危险因素分析16引言16第一章 研究对象及方法1 711研究对象1712 研究方法1713 统计学处理1 8第二章 结果1921 基本情况比较一1922 围产期因素、营养支持、治疗措施级并发症比较1923 高危因素一21第三章 讨论一23结论25参考文献26综述机械通气早产几早期微量喂养的研究进展27综述参考文献32攻读学位期间的研究成果。349ft录35致谢。38声明。39青岛大学硕士学位论文第一部分呼吸窘迫综合征的早产儿宫外发育迟缓的临床观察引言新生儿呼吸窘迫综合征(RDS)为肺表面活性物质(pulmonary surfactant,PS)缺乏及肺结构发育不成熟所致,多见于早产儿,生后数小时出现进行性呼吸困难、青紫和呼吸衰竭。近年来,随着新生儿重症监护室(neonatal intensive care unitNICU)建立,产前激素应用、PS的替代治疗和呼吸机的支持治疗技术的日益成熟,提高了RDS患儿的成活率,但因该类患儿病情危重,且多实行机械通气,致其营养不足宫外发育迟缓问题日益凸显。目前针对RDS患儿发育迟缓情况研究较少,本文对我院收治并抢救存活出院70例RDS早产儿的宫外发育迟缓情况进行分析,探讨RDS早产儿的宫外发育迟缓及早期营养干预的效果。第一部分第一章研究对象及方法第一部分呼吸窘迫综合征的早产儿宫外发育迟缓的临床观察11研究对象第一章研究对象及方法2011年1月至2012年lO月入住我院新生儿重症监护室(NICU)的患有RDS的早产儿70例。纳入标准:胎龄37周;入院年龄24小时;住院时间7天;

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