影响气管插管机械通气新生儿预后的相关因素

The affecting factors of prognosis of neonate with trachea cannula and mechanical ventilation

目的 探讨影响气管插管、机械通气新生儿预后的相关因素。方法对7年来气管插管、机械通气的新生儿进行总结,对影响预后的相关因素作一简要分析。结果 影响预后的主要因素中颅内出血、NRDS、重度窒息、重度硬肿症的病死率达71.4%-100%,大大高于单纯肺炎合并呼衰(14.3%);危重度评分的高低与病死率负相关,分值越高病死率越低,反之分值越低病死率越高;脏器衰竭的程度与数目亦和预后密切相关,重度多脏器损伤组病死率高于轻中度单脏器组,二者有显著性差异;插管时机的选择对预后也有一定影响,及早插管机械通气治疗组的病死率44.0%,而延迟插管甚至临终插管组的病死率升至73.3%;而不同通气方式及体重对预后的影响相对较小。结论及时的气管插管、合理的机械通气治疗、严格的呼吸道管理、严密的呼吸监测及并发症的有效防治、全身支持治疗,防止脏器损伤程度的加重和受累脏器数量的序贯发生能显著改善预后。

Objective The affecting factors of trachea cannula and mechanical ventilation of newborn Find out the factors that affect trachea cannula and mechanical ventilation of neonate. Methods By summarizing trachea cannula and mechanical ventilation of the newborn in the past 7 years, give a brief analysis of the factors affecting prognosis. Results Primary disease is the main factor affecting prognosis. The mortality of in-tracranial hemorrhage of the newborn,NRDS( neonatal respiratory distress syndrome) ,severe asphyxia and se- vere neonatal scleredeme is 71.4% - 100% , much higher than that of the pneumonia with respiratory failure, which is 14.3% . Critical-scorings in inverse variation with the mortality. The higher the rate, the lower the mortality and vice versa. The degree and the number of the organ failure is also closely related with prognosis. The mortality between the multi-organ system failure (MOSF) and the mild-middle organ failure has marked difference, with the former higher than the latter. When to insert the trachea cannula also affects prognosis. The mortality of inserting the trachea cannula for mechanical ventilation early is 44.0% while the mortality of doing so late rises to 73.3% . The different ways of ventilation and the weight have relatively smaller effect on prognosis. Conclusion Timely trachea cannula, proper mechanical ventilation , strict respiratory control, strict respiratory overseeing and the preventive measures against complication,overall supportive treatment, prevention of the aggravation of organ failure can considerably improve prognosis.