机械通气治疗新生儿肺透明膜病的临床分析

Clinical analysis of mechanical ventilation treatment for pulmonary hyaline membrane disease in newborn

目的探讨新生儿肺透明膜病(HMD)的呼吸机治疗,分析相关干预措施和围生期因素对疾病转归的影响。方法回顾性分析我院新生儿重症监护病房(NICU)2002年7月～2004年9月收治的35例经机械通气治疗的HMD患儿临床资料,对HMD治愈组和未愈组的呼吸机参数、肺表面活性物质(PS)和静脉营养的应用、胎龄、出生体重、新生儿Apgar评分、宫内缺氧等进行比较。结果呼吸机治疗HMD的治愈率为71.4%,呼吸机相关性肺炎的发生率为34.3%。HMD治愈组和未愈组的呼吸机初调参数及最高参数中的吸入氧浓度(FiO2)、呼吸频率(RR)、呼气末正压(PEP)和吸气时间(Ti)等,以及胎龄、5分钟Apgar评分比较两组间均无显著性差异(P>0.05);出生体重、1分钟Apgar评分、宫内缺氧、最高参数中的吸气峰压(PIP)、静脉营养天数及应用PS等方面两组间存在显著性差异(均P<0.05)。结论围生期一些高危因素影响HMD的转归,机械通气是治疗HMD的重要手段,同时辅以PS和静脉营养应用可提高HMD的治愈率。

Objective To explore the effect of assisted mechanical ventilation on hyaline membrane disease （HMD） of newborn, and to analyze the remedies and perinatal risk factors of affecting the prognosis of HMD. Methods Thirty-five newborns with HMD were treated by respirator in NICU between July, 2002 to September, 2004. The differences of operator parameters, use of pulmonary surfactant and parenteral nutrition, birth weight, Apgar score, and fetal hypoxia between the .cured group and uncured group were compared. Results The percentage of curing of HMD by respirator was 71.4%, and the most sommon complication was the ventilator associated pneumonia （34.3 % ）. There was no significant difference between the cured group and uncured group in initial parm^- ters of ventilator, and F1O2, respiratoryl rate（RR）, positive end-expirator pressure （PEEP） time of inspiration（Ti） among the highest parameters, gestationl age, Apgar score at 5 min （all P 〉 0.05）. But the significant differences between the two groups were observed ih birth weight, Apgar score at 1 min, fetal hypoxia, peak inspiratory pressure （PIP） of the highest parameters, the use of surfactant and parenteral nutrition （all P 〈 0.05）. Conclusion ~ Some of perinatal high risk factors contribute to prognosis of HMD. Assisted mechanical ventilation, an important procedure in the treatment of HMD, combined with the use of surfactant and parenteral nutrition can improve its survival rate.