MAS 是一种严重的并发症,与羊水胎粪污染 (meconium-stained amniotic fluid, MSAF) 相关。总体而言,在足月分娩中,MSAF 占 7%-22%,在过期分娩(>42 周)中,所占比例更高(22%-44%)。[3]Cleary GM, Wiswell TE. Meconium-stained amniotic fluid and meconium aspiration syndrome: an update. Pediatr Clin North Am. 1998 Jun;45(3):511-29.http://www.ncbi.nlm.nih.gov/pubmed/9653434?tool=bestpractice.com[4]Dargaville PA, South M, McDougall PN. Surfactant and surfactant inhibitors in meconium aspiration syndrome. J Pediatr. 2001 Jan;138(1):113-5.http://www.ncbi.nlm.nih.gov/pubmed/11148523?tool=bestpractice.com 在黑人和南亚人妊娠期间 MSAF 的发病率较高。[5]Balchin I, Whittaker JC, Lamont RF, et al. Maternal and fetal characteristics associated with meconium-stained amniotic fluid. Obstet Gynecol. 2011 Apr;117(4):828-35.http://www.ncbi.nlm.nih.gov/pubmed/21383642?tool=bestpractice.com 在小于 34 周的早产儿中不常见(<5%)。 早产儿 MAS 发生率低可能与早产儿的肠蠕动功能尚未发育成熟、因而 MSAF 发生率低相关。[1]Rossi EM, Philipson EH, Williams TG, et al. Meconium aspiration syndrome: intrapartum and neonatal attributes. Am J Obstet Gynecol. 1989 Nov;161(5):1106-10.http://www.ncbi.nlm.nih.gov/pubmed/2589429?tool=bestpractice.com 1% 的婴儿出生时有少量胎粪,7%有大量胎粪。[6]Wiswell TE, Pinchi S. Aspiration syndromes in neonatal respiratory disorders. In: Greenough A, Milner AD, eds. Neonatal respiratory disorders. London, UK: Arnold; 2003:350.
尽管二十世纪 90 年代美国 MAS 的发生率有所下降,但之后有报告显示,MAS 仍然是一个需要关注的问题。[7]Yoder BA, Kirsch EA, Barth WH, et al. Changing obstetric practices associated with decreasing incidence of meconium aspiration syndrome. Obstet Gynecol. 2002 May;99(5 Pt 1):731-9.http://www.ncbi.nlm.nih.gov/pubmed/11978280?tool=bestpractice.com[8]Singh BS, Clark RH, Powers RJ, et al. Meconium aspiration syndrome remains a significant problem in the NICU: outcomes and treatment patterns in term neonates admitted for intensive care during a ten-year period. J Perinatol. 2009 Jul;29(7):497-503.http://www.ncbi.nlm.nih.gov/pubmed/19158800?tool=bestpractice.com 来自 1997-2007 年新生儿重症监护病房收住的 415,772 例新生儿的数据显示,39% (162,075例) 为足月产(大于 37 周),其中 4.6% 诊断为 MAS。[8]Singh BS, Clark RH, Powers RJ, et al. Meconium aspiration syndrome remains a significant problem in the NICU: outcomes and treatment patterns in term neonates admitted for intensive care during a ten-year period. J Perinatol. 2009 Jul;29(7):497-503.http://www.ncbi.nlm.nih.gov/pubmed/19158800?tool=bestpractice.com 澳大利亚和法国的人口研究也显示:在过去十年中,MAS 和 MSAF 的发生率平稳下降。[9]Fischer C, Rybakowski C, Ferdynus C, et al. A population-based study of meconium aspiration syndrome in neonates born between 37 and 43 weeks of gestation. Int J Pediatr. 2012;2012:321545.http://www.hindawi.com/journals/ijpedi/2012/321545/http://www.ncbi.nlm.nih.gov/pubmed/22187569?tool=bestpractice.com[10]Vivian-Taylor J, Sheng J, Hadfield RM, et al. Trends in obstetric practices and meconium aspiration syndrome: a population-based study. BJOG. 2011 Dec;118(13):1601-7.http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2011.03093.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/21895951?tool=bestpractice.com
MAS 的发生率与孕龄的增加有关:37 周为 1.1%,>42 周时为 24%。 其中,81.5% 的婴儿出院回家,9%被转运至更高级别的新生儿监护室,5.5% 转至同院的其他临床科室,1.2% 死亡,1.4%需行体外膜肺氧合治疗 (ECMO)。 进行 ECMO 治疗的 MAS 患儿其存活率为 94%。[11]Short BL. Extracorporeal membrane oxygenation: use in meconium aspiration syndrome. J Perinatol. 2008 Dec;28(suppl 3):S79-83.https://www.nature.com/articles/jp2008152http://www.ncbi.nlm.nih.gov/pubmed/19057615?tool=bestpractice.com 在一篇综述中,比较了对足月或过期妊娠进行催产与期待疗法的益处,结果表明:对过期妊娠行催产处理可使发生 MAS 的婴儿减少,引产减少了围产期死亡。[12]Middleton P, Shepherd E, Crowther CA. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database Syst Rev. 2018 May 9;(5):CD004945.https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004945.pub4/fullhttp://www.ncbi.nlm.nih.gov/pubmed/29741208?tool=bestpractice.com [
]In women at or beyond term, how does induction of labor compare with expectant management for infant outcomes?https://www.cochranelibrary.com/cca/doi/10.1002/cca.2195/full显示答案
MSAF 和 MAS 的发生率和死亡率在发展中国家更高。[13]Velaphi S, Van Kwawegen A. Meconium aspiration syndrome requiring assisted ventilation: perspective in a setting with limited resources. J Perinatol. 2008 Dec;28(suppl 3):S36-42.https://www.nature.com/articles/jp2008155http://www.ncbi.nlm.nih.gov/pubmed/19057609?tool=bestpractice.com[14]Anwar Z, Butt TK, Kazi MY. Mortality in meconium aspiration syndrome in hospitalized babies. J Coll Physicians Surg Pak. 2011 Nov;21(11):695-9.http://www.ncbi.nlm.nih.gov/pubmed/22078351?tool=bestpractice.com