极低出生体重儿并发慢性肺发育不良的防治

Clinical study on the prevention of chronic pulmonary hypoplasia in very low birth weight infants

目的探讨不同方式预防极低出生体重儿(VLBWI)在机械通气治疗中并发慢性肺发育不良(BPD)的效果。方法71例VLBWI的胎龄(30±2)周,出生体重平均(1235.2±160.6)g。分别于机械通气治疗中应用方案Ⅰ为允许性高碳酸血症(PHC)组32例,方案Ⅱ为肺表面活性物质(PS)气管滴入组20例,方案Ⅲ为必可酮(BDP)气雾组19例。对三组呼吸机设置、血气分析结果、临床表现和治疗效果进行比较。结果方案Ⅰ呼吸机参数吸气峰压(PIP)和通气频率(VR)分别为(18.3±1.6)cmH2O和(35±5)bpm,显著低于方案Ⅱ、Ⅲ组(P<0.01);三组血气分析PaCO2、HCO3-有明显差异(P<0.01),但pH值、PaO2差异无统计学意义(P>0.05)。BPD的发生率方案Ⅰ为16%(5/32),方案Ⅱ为5%(1/20),方案Ⅲ为5%(1/19)。病死率方案Ⅰ为6%(2/32),方案Ⅱ为5%(1/20)。结论应用允许性高碳酸血症、肺表面活性物质气管滴入、必可酮气雾均可有效地预防VLBWI在机械通气治疗中并发严重支气管肺发育不良。

Objective To explore the effect of different method in preventing broncho-pulmonary dysplasia （BPD） in very low birth weight infants（VLBWI） during mechanical ventilation. Methods The gestational age of 71 infants with VLBWI was （30 ± 2） weeks and the average weight was （1235.2 ± 160.6）g. The infants were randomly divided into three groups, they received different therapeutic regimens during mechanical ventilation：32 eases were treated with permissive hypereapnia（PHC） ventilation in group Ⅰ ;20 cases were treated by intratraeheal instillation of pulmonary surfaetant（PS） in group Ⅱ ;19 eases were treated by inhalation of beeotide（beclomethasone dipropionate,BDP） in group Ⅲ. The ventilator settings, blood gas analysis, clinical symptoms and therapeutic effect were statistically analyzed and compared. Results The peak inspiratory pressure（PIP） and ventilation rate（VR） of ventilator parameter were （18.3 ± 1.6）emH20 and （35 ± 5）bpm in group Ⅰ ,there was significantly lower than that in group Ⅱ and group m （P 〈 0.01 ）; For blood gas analysis, there was significant difference in PaCO2 and HCO3^- among three group（ P 〈 0.01 ）, but there was no significant difference in pH value and PaO2 （ P 〉 0.05 ）. The incidence of BPD was 16% （5/32） in group Ⅰ ,5% （1/20） in group Ⅱ and 5% （1/19） in group Ⅲ ;The mortality rate of PHC group（group Ⅰ ） was 6% （2/32） and 5 % （1/20） in group Ⅱ . Conclusion The application of permissive hypercapnia,intraeheal instillation of pumlonary surfaetant and inhalation of becotide all can prevent effectively the occurrence of severe broncho-pulmonary dysplasia in VLBWI during mechanical ventilation.