使用呼吸器治疗体会及其并发症的防治

Early Diagnosis and Treatment of Complication on Neonatal Mechanical Ventilation

目的提高呼吸器治疗患儿的存活率及减少并发症。方法对1990～1997年我科NICU 行人工通气的58例新生儿的临床资料进行总结分析。结果 58例行人工通气的新生儿,平均呼吸器使用时间:60.06±38.07小时,合并症以过度通气最多占53%,脱管19例(23次)占33%及(40%),堵管、继发感染各8例占14%,插管不当及拔管后肺不张各6例占10%,气胸4例(7%)。58例存活37例占64%,死亡9例(16%)、放弃12例(21%)。结论针对处理不当所致并发症提出了进一步加强呼吸道管理的措施,呼碱的防治及拔管后肺不张的诊断及处理措施,提出了胎粪吸入综合征(MAS)、肺出血人工通气治疗方面的体会。

Objectives To improve cure rate and reduce complications of ventilated infants. Methods Mechanical ventilation in 58 neonatas were used.The average time for using respirator was 60±38 hours.Results The complications consisted in overventilation 53% ,drop down of endotra- cheal tube 33%,blockage of endotracheal tube and secondary infection 14%,inappropriate intubation and atelectasis after extubation 10%,pneumothoroax 6.9%.In the 58 neonates 37 cases(64%)sur- vived,9 cases(16%)died,12 cases(21%)abandoned.Conclusions We suggested (1)enhance- ment of respirtory management,(2)adjust respiratory alkalosis.(3)early diagnosis and treatment ateletasis after extubation.Finaly we presented our experiences in early diagnosis and treatment of pulmonary hemorrhage and the artificial ventilation of MAS and pneumothorax.