早产儿肺出血危险因素及早期诊治

PREMATURE PULMONARY HEMORRHAGE:RISK FACTORSAND EARLY DIAGNOSIS AND MANAGEMENT

本文报告了8例早产儿肺出血。原发疾病为RDS、窒息、DIC。早产是肺出血的生理性危险因素，缺氧、酸中毒、DIC、羊水吸入等是病理性危险因素，机械通气压力变化过快或导致严重肺气肿和过度通气是医源性危险因素。根据气管插管内吸出带血痰液、肺部出现罗音和胸片呈现大片融合阴影及肺透高度减低可诊断早期肺出血。在应用正压通气治疗肺出血时，压力改变要稳妥，避免过度通气或严重肺气肿。

We summarized 8 cases of premature pulmonary hemorrhage, emphasized on primary diseases and clinical menifestation 24-48 hours before pulmonary hemorrhage. The results showed that primary diseases of pulmonary hemorrhage in our study are respiratory distress syndrome, neonatal asphyxia,disseminated intravascular coagulation(DIC)and severe amniotic fluid aspiration. Prematurity is a physiological risk factor of pulmonary hemorrhage. Hypoxia, acidosis, DIC and amniotic fluid aspiration are pathological risk factors. The presence of inappropriate usage of mechanical ventilation is nosocomial agent which cause pulmonary hemorrhage. Bleeding diathesis,ventilation pressure changing too fast,severe emphysema and over ventilation are all inducing factors. According to the bleeding sputum which is suctioned from trachea, lungs fine ralee appearsnce and chest X-ray findings large patchy infiltrates could diagnose pulmonary hemorrhage early. The main management is positive pressure ventilation. Dropping 1: 10000 epinephrine into trachea is effective. It is important to eliminate risk and inducing factors,use ventilation carefully and prevent over ventilation and emphysema