| 摘要: | 目的：很少有文獻討論胎便吸入症候群（胎吸症）長期的預後。我們假設胎吸症的嬰兒除非有窒息、休克等會造成腦部貫流不足的併發症，否則其神經發展的預後應是正常的。本研究嚐試探討本院近六年來胎吸症在2歲時神經發展的預後，以期能找出影響胎吸症長期預後的原因。方法：自1995年1月到2001年12月，在本院高危險嬰兒追蹤門診，對胎吸症的病嬰進行前瞻性的研究。胎吸症、窒息、休克、氣胸、肺出血、新生兒肺動脈高壓的診斷是由二位新生兒專家作獨立診斷。完整神經發育的測試是在第24個月時由新生兒專家作評估，評估內容包括神經和心智。運動神經是以GMS來檢視，結果分為正常（GMS>84）：暫時性（70至84）：和不正常<70。以貝利式心智測驗評估心智和行為的發展，>100表示超齡發育，70至84表示輕度遲緩，55至69表示中度遲緩，<55則表示嚴重遲緩，此檢查由有經驗的專業心理師作評估。結果：七年間共有327例胎吸症，15例死亡，312例存活。其中有285/312例完成至2歲的追蹤。5例有聽力障礙，7例有痙攣，3例有輕度心智遲緩，7例有中度心智遲緩，5例有重度心智遲緩。心智遲緩的比例（12/285）和一般正常足月兒稍高但沒有統計上的意義。雙變項分析顯示中度以上的心智遲緩和周產期的因素如性別、院內或院外，胎位正常與否，自然或剖腹產，懷孕週數、出生體重等無關。也和病嬰至加護病房後的酸鹼值、動脈血氣和二氧化碳的濃度無關。但和窒息（p<0.01）、新生兒痙攣（p<0.01）、休克（p=0.02）、使用高頻呼吸器（p=0.04）、使用表面張力素（p<0.01）、呼吸器使用天數有關。結論：我們初步的結論是胎吸症的嬰兒發生中重度遲緩的比例較足月正常新生兒為高。其主因是胎吸症合併缺氧或缺血，和胎吸症本身無關。胎吸症病嬰併發、窒息、休克、新生兒痙攣、等等時應長期追蹤，以利早療並減少醫療的支出。
Objectives: Few published papers have discussed the long-term neurodevelopment outcome of MAS. The aim of this prospective study was to investigate the neurodevelopment of neonate with MAS at 2 years of age. Methods: From 1995 to 2003, a prospective clinical study was conducted at the high risk follow up clinic. MAS was diagnosed by the presence of meconium below the vocal cord, accompanied by respiratory distress with tachypnea, retraction, cyanosis and an abnormal chest X-ray finding. Patients with cyanotic heart disease or fetal congenital malformations were excluded. Asphyxia, pneumothorax, pulmonary hemorrhage, PPHN, bronchopulmonary dysplasia were diagnosed by a neonatologist. Oxygen, nasal continuous positive airway pressure (CPAP), and conventional mechanical ventilation, surfactant, HFO, INO decadron were applied as clinically indicated. Neurodevelopment assesment was evaluated by GMS, the baley test and infant crib. Results: There were 327 cases of MAS during 7 years;312 infants survived, and 285 infants completed the follow up program at 2 years of age. Seven infants had chronic sejiure, 3 infants had mild neurodevelopment delay, 7 infants had moderate neurodevelopment delay, and 5 infants had sever neurodevelopment delay. Univarient analysis revealed asphyxia, shock, and neonatal seizure. High frequency ventilation, surfactant and days of ventilation were the risk factors for moderate to severe neurodevelopment delay. Conclusions: We conclude that few of the cases had neurological sequela. Unless it is associated with hypoxia or ischemia, MAS alone does not increase the risk of neurodevelopement sequela in neonates with MAS. |
