Chinese Medical E-ournals Database

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2015, Vol. 11 ›› Issue (06): 774 -779. doi: 10.3877/cma.j.issn.1673-5250.2015.06.020

Special Issue:

Original Article

Typing characteristics and determining indicators of severe meconium aspiration syndrome

Junchao Wu1, Jingqing Yang2, Junmin Liu2, Guangchun Jiang2, Yongbin Liu2, Kai Tie3, Hui Wang3, Guohua Yang3()   

  1. 1. Department of Medical Genetics, Wuhan University School of Basic Medical Sciences, Wuhan 430071, Hubei Province, China; Department of Pediatrics, Suizhou Maternal and Child Health Hospital, Wuhan 441300, Hubei Province, China
    2. Department of Pediatrics, Suizhou Maternal and Child Health Hospital, Wuhan 441300, Hubei Province, China
    3. Department of Medical Genetics, Wuhan University School of Basic Medical Sciences, Wuhan 430071, Hubei Province, China
  • Received:2015-07-08 Revised:2015-11-10 Published:2015-12-01
  • Corresponding author: Guohua Yang
  • About author:
    Corresponding author: Yang Guohua, Email:
Objective

To investigate the characteristics of different clinical types of severe meconium aspiration syndrome (MAS), and provide a scientific basis for classification of severe MAS by the disease treatment.

Methods

From January 2008 to December 2011, a total of 236 hospitalized cases who were diagnosed with severe MAS in Suizhou Maternal and Child Health Hospital Center were included in the study.They were divided into heavy MAS group(n=158) and critical MAS group(n=78). There were no statistically significant differences in gender constituent ratio, gestational age, birth weight between two groups(P>0.05). With the same method, another 127 hospitalized case were also chosen in the study from January 2012 to December 2013, and they were divided into verification of heavy MAS group(n=88) and verification of critical MAS group(n=39). There were no statistically significant differences in gender constituent ratio, gestational age between two groups either(P>0.05). The clinical manifestations, laboratory examination results, auxiliary examination results, complications and prognosis were observed.The results of single factor analysis was statistically significant for multi-factor unconditioned logistic regression analysis. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Suizhou Maternal and Child Health Hospital. Informed consent was obtained from each participants' parents.

Results

There were significant differences in 7 kinds of clinical manifestations such as coma, convulsions, breathing difficulties, the duration of cyanosis ≥3 d and so on between two groups(P<0.05); The differences in incidence rates of partial pressure of oxygen (PaO2)<50 mmHg (1 mmHg=0.133 kPa), partial pressure of carbon dioxide (PaCO2)>60 mmHg, pH value<7.25 and base excess <-5 were significant between two groups(P<0.05). The incidence rates of atelectasis, pulmonary emphysema and pulmonary gas leakage in critical MAS group were significant higher than those of heavy MAS group(P<0.05). There were significant differences in 7 kinds of complications between two groups(P<0.01), and the differences in cure rate and mortality between two groups had statistical significance(P<0.05). Multiple logistic regression analysis and receiver operating characteristics (ROC) curve showed that the duration of breathing difficulties and cyanosis ≥3 d, arterial blood PaCO2>65 mmHg, lung gas leakage were the independent forecasts determine index of critical intensive MAS .The results of prospective Kappa test in two verification groups showed that Youden index was 0.95, Kappa value was 0.945, and its sensitivity was 0.97, specificity was 0.98.

Conclusions

The children with the duration of breathing difficulties and cyanosis ≥3 days, arterial blood PaCO2>65 mmHg, lung gas leakage can be diagnosed as critical intensive MAS.

表1 两组重症MAS患儿一般情况比较[例数(%)]
表2 两组重症MAS患儿临床表现比较[例数(%)]
表3 两组重症MAS患儿实验室检查结果比较[例数(%)]
表4 两组重症MAS患儿胸部X射线摄片结果比较[例数(%)]
表5 两组重症MAS患儿并发症及转归比较[例数(%)]
表6 危重型重症MAS判断指标的多因素非条件logistic回归分析
表7 不同PaCO2水平对危重型重症MAS的诊断效能
图1 PaCO2诊断危重型重症MAS的ROC曲线
表8 危重型重症MAS判断指标的验证结果[例数(%)]
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