新生儿慢性肺疾病的机械通气策略研究

Mechanical ventilation strategies in neonates with chronic lung disease

目的探讨新生儿慢性肺疾病发生前后的机械通气方法。方法对24例新生儿慢性肺疾病(CLD)在确诊前后均进行以保护性肺通气为策略的机械通气为主的综合治疗,回顾性分析其临床资料。结果全组慢性肺疾病新生儿共24例,死亡2例,病死率8.3%,好转出院1例(4.2%),其余21例痊愈出院(87.5%);确诊CLD后有9例患儿仍需要应用呼吸机辅助通气,7例痊愈出院;8例曾应用激素治疗,但有3例因出现副作用而停药。结论保护性肺通气策略是新生儿慢性肺疾病预防和治疗的重要措施,选用鼻塞间歇指令通气或鼻塞持续气道正压作为撤机方式,可提高治疗效果;CLD发生后容许性高碳酸血症的应用有助于疾病的恢复。

Objective To study the mechanical ventilation strategies in neonates with chronic lung disease （CLD） before and after the onset of the disease. Methods Twenty-four neonates with CLD were mechanically ventilated with lung-protective ventilation strategies before and after the diagnosis was made, and their clinical data were retrospectively analyzed. Results Among these twenty-four neonates, there were two death （8. 3% ）, one improved （4. 2% ）, and the other twenty-one babies recovered completely and were discharged home （87.5%）. Nine babies were ventilated intermittently after CLD diagnosed, seven of them survived and were discharged home. Steroid treatment was started on eight neonates with CLD and three of them were discontinued because of side effects. Conclusions Lung-protective ventilation strategies are effective and important methods for prevention and treatment of neonatal CLD. Nasal intermittent mechanical ventilation or nasal continuous positive airway pressure ventilation is an effective method waning infants from ventilator.