对新生儿呼吸机所致合并症的防治

Prophylaxis and treatments of the complications in the newborns treated with mechanical ventilation

为了降低呼吸机治疗的合并症，提高治愈率，以１９８５～１９８９年有合并症的５７例（甲组）与１９９０～１９９５年改进防治措施后有合并症的１０７例（乙组）进行对比。结果：（１）治愈率甲乙两组分别为２８．１％及５３．５％（χ２＝８．８９，Ｐ＜０．０１），病死率分别为６３．１％及１７．８％（χ２＝３４．３９，Ｐ＜０．０１）；（２）在合并症中，插管不当分别为５６．１％及１７．８％，肺气压伤分别为３１．６％及５．６％，肺不张分别为２８．１％及９．３％（χ２分别为２５．５７、２０．０８、９．７７，Ｐ均＜０．０１），感染加重分别为４６．１％及２３．５％（χ２＝４．６２），拔管过早分别为５．３％及０，（Ｐ均＜０．０５）。说明乙组的合并症明显低于甲组。提示：在１９９０～１９９５年改进治疗措施后，呼吸机治疗时常见的七项合并症的发生率明显降低。

To reduce the incidence of complications and improve the cure rate, the authors analysed the preventive and treating measures of 57 neonates during 1985 1989 (group A) and 107 cases during 1990～1995 (groups B) under mechanical ventilation treatment. There were no significant difference between the two groups in clinical data ( P >0.05). The results showed that: 1) the cure rates of group A and B were 28.1% and 53.5%, and the mortality rates were 63.1% and 17.8%, respectively (both P <0.01), the cure rate was signficantly higher and the mortality lower in group B; 2) the complications included: unsuitable endotracheal intubation in 56.1% and 17.8% for group A and B, respectively, barotrauma of the lungs (31.6% and 5.6% for group A and B), atelectasis (28.1% and 9.3% for group A and B), aggravated infection of the lungs (46.1% and 23.5% for group and B), extubated too early (5.3% and 0 for group A and B) ( P <0.05～0.01). These results indicated that the incidences of complication in group B were significantly lower than those in group A, which suggested that the complcations in the newborns with mechanical ventilation were obviously minimized with the application of preventive and treating measures to these cases.