新生儿失血性休克的病因及临床特点分析(1)
摘要：目的 探討新生儿失血性休克的病因及临床特点。方法 收集2016年2月～2020年2月收治于我院新生儿重症监护病房42例新生儿失血性休克患儿的资料，就其病因、临床表现、实验室检查、治疗及预后等相关项目进行回顾性分析。结果 42例失血性休克患儿中早产儿25例，足月儿17例;产前、产时失血共计10例(23.81%)，其中足月儿6例，早产儿4例;按休克评分分度：轻度14例，中度21例，重度7例。胎儿母体输血在产前产时出血原因中占比最高;产后失血共计32例(76.19%)，其中颅内出血和肺出血占产后出血原因的前2位，其中足月儿12例，早产儿21例。所有患儿都有毛细血管充盈时间延长、皮肤颜色改变等末梢微循环障碍的表现，85.71%的患儿肢端温度降低;神志改变以反应低下最为常见，占80.95%，有呼吸节律改变或呼吸困难者占64.29%;治愈好转34例，死亡3例，放弃5例。结论 新生儿失血性休克多起病隐匿，产前及产时失血主要由胎-胎输血、胎母输血、胎儿-胎盘输血等引起。产后出血主要为颅内出血、肺出血、肾上腺出血、肝脏出血及胸腹腔积血。临床表现不典型，早产儿更易发生失血性休克，医源性失血加大了早产儿患病风险。
关键词：失血性休克;新生儿;病因
中图分类号：R722.1 文献标识码：B DOI：10.3969/j.issn.1006-1959.2020.20.058
文章编号：1006-1959(2020)20-0180-04
Analysis of the Etiology and Clinical Characteristics of Neonatal Hemorrhagic Shock
LIU Yu，NING Jin-bo，YI Ming，DUAN Wei
(Department of Pediatrics，Three Gorges Hospital，Chongqing University，Chongqing 404000，China)
Abstract：Objective To explore the etiology and clinical features of neonatal hemorrhagic shock.Methods The data of 42 children with neonatal hemorrhagic shock admitted to the neonatal intensive care unit of our hospital from February 2016 to February 2020 were collected， and the etiology， clinical manifestations， laboratory examinations， treatment and prognosis and other related items were collected retrospective analysis.Results Among the 42 children with hemorrhagic shock， 25 were premature babies and 17 were full-term babies. There were 10 cases (23.81%) of prenatal and intrapartum blood loss， including 6 full-term babies and 4 premature babies. According to shock scores degree： 14 cases were mild， 21 cases were moderate， and 7 cases were severe. Fetal maternal blood transfusion accounts for the highest proportion of prenatal and intrapartum hemorrhage; 32 cases of postpartum blood loss (76.19%)， of which intracranial hemorrhage and pulmonary hemorrhage accounted for the top two causes of postpartum hemorrhage， including 12 full-term infants and 21 preterm infants example. All children had symptoms of peripheral microcirculation disorders such as prolonged capillary filling time and changes in skin color. 85.71% of the children had a lower extremity temperature; mental changes were the most common， accounted for 80.95%， with changes in respiratory rhythm or respiration difficulties accounted for 64.29%; 34 cases were cured， 3 cases died， and 5 cases gave up.Conclusion The onset of neonatal hemorrhagic shock was often insidious. The prenatal and intrapartum blood loss was mainly caused by fetal-fetal blood transfusion， fetal-maternal blood transfusion， and fetal-placental blood transfusion. Postpartum hemorrhage was mainly intracranial hemorrhage， pulmonary hemorrhage， adrenal hemorrhage， liver hemorrhage and hemorrhage in the chest and abdominal cavity. The clinical manifestations were atypical， preterm infants were more likely to have hemorrhagic shock， and iatrogenic blood loss increases the risk of preterm infants., http://www.100md.com(刘渝 宁金波 易明 段娓)
关键词：失血性休克;新生儿;病因
中图分类号：R722.1 文献标识码：B DOI：10.3969/j.issn.1006-1959.2020.20.058
文章编号：1006-1959(2020)20-0180-04
Analysis of the Etiology and Clinical Characteristics of Neonatal Hemorrhagic Shock
LIU Yu，NING Jin-bo，YI Ming，DUAN Wei
(Department of Pediatrics，Three Gorges Hospital，Chongqing University，Chongqing 404000，China)
Abstract：Objective To explore the etiology and clinical features of neonatal hemorrhagic shock.Methods The data of 42 children with neonatal hemorrhagic shock admitted to the neonatal intensive care unit of our hospital from February 2016 to February 2020 were collected， and the etiology， clinical manifestations， laboratory examinations， treatment and prognosis and other related items were collected retrospective analysis.Results Among the 42 children with hemorrhagic shock， 25 were premature babies and 17 were full-term babies. There were 10 cases (23.81%) of prenatal and intrapartum blood loss， including 6 full-term babies and 4 premature babies. According to shock scores degree： 14 cases were mild， 21 cases were moderate， and 7 cases were severe. Fetal maternal blood transfusion accounts for the highest proportion of prenatal and intrapartum hemorrhage; 32 cases of postpartum blood loss (76.19%)， of which intracranial hemorrhage and pulmonary hemorrhage accounted for the top two causes of postpartum hemorrhage， including 12 full-term infants and 21 preterm infants example. All children had symptoms of peripheral microcirculation disorders such as prolonged capillary filling time and changes in skin color. 85.71% of the children had a lower extremity temperature; mental changes were the most common， accounted for 80.95%， with changes in respiratory rhythm or respiration difficulties accounted for 64.29%; 34 cases were cured， 3 cases died， and 5 cases gave up.Conclusion The onset of neonatal hemorrhagic shock was often insidious. The prenatal and intrapartum blood loss was mainly caused by fetal-fetal blood transfusion， fetal-maternal blood transfusion， and fetal-placental blood transfusion. Postpartum hemorrhage was mainly intracranial hemorrhage， pulmonary hemorrhage， adrenal hemorrhage， liver hemorrhage and hemorrhage in the chest and abdominal cavity. The clinical manifestations were atypical， preterm infants were more likely to have hemorrhagic shock， and iatrogenic blood loss increases the risk of preterm infants., http://www.100md.com(刘渝 宁金波 易明 段娓)