新生儿肺透明膜的呼吸支持治疗效果分析

The Effect Analysis of Hyaline Membrane Respiratory Support Treatment

目的探讨新生儿肺透明膜病(HMD)呼吸支持治疗的综合诊治,总结并提出新生儿肺透明膜病的呼吸支持治疗的预后措施。方法对本院近2年接收的52例新生儿肺透明膜病的临床诊治进行回顾性分析,把患儿分为固尔苏治疗组和未使用固尔苏治疗两组。52例患儿均进行了对症呼吸支持治疗,供氧治疗,在治疗过程中根据患儿的血氧饱和度、血气检查进行氧气的供给调整。52例患儿中12例进行头罩吸氧,13例患儿进行鼻塞式持续正压通气(CPAP),9例因患儿病情严重无法改善,采用机械通气治疗;7例患儿X线片胸部为Ⅲ、Ⅳ级均直接进行了机械通气治疗,11例患儿应用肺泡表面活性药物(PS)固尔苏进行治疗。结果 52例新生儿肺透明膜病中治疗痊愈的有31例(78.00%),2例患儿因病情严重恶化放弃治疗(5.66%),7例治疗过程中死亡(16.67%)。使用固尔苏治疗的患儿组病死率明显低于未使用固尔苏治疗治疗组(P<0.05),患儿辅助机械通气时间显着缩短(t=2.4252,P<0.01);诊断胸片为Ⅲ、Ⅳ级的改变者较胸片改为Ⅰ、Ⅱ级的机械通气时间长(t=3.7630;P<0.01),病死率高(P<0.01)。结论新生儿肺透明膜治病病死率高,应加强孕妇围产期保健;应该肺泡活性药物固尔苏(PS)能有效改善肺透明膜的预后;新生儿体质量大于1800g,胸片改变为Ⅰ、Ⅱ级的新生儿肺透明膜临床诊治综合预后较好,Ⅲ、Ⅳ级预后差。

Objective Explored the comprehensive diagnosis and treatment of hyaline membrane disease（HMD） respiratory support treatment,summarized the neonatal measures of HMD respiratory support treatment.Methods Retrospectively analyzed 52 cases with HMD in our hospital for nearly 2 years,divided into the Curosurf group and no use Curosurf group.all 52 cases with symptomatic respiratory support treatment,oxygen treatment,during treatment of children with oxygen saturation,blood gas to check the oxygen supply.Results Cured in 52 cases of HMD in 31 cases（78.00%）,2 cases with serious deterioration so gave up treatment（5.66%）,7 cases during the treatment died（16.67%）.Curosurf children mortality rate was significantly lower than the unused Curosurf treatment group（P 0.05）,children assisted mechanical ventilation time was significantly shortened（t = 2.4252,P 0.01）;diagnostic chest X-rayfor Ⅲ of grade Ⅳ change compared to chest X-ray instead Ⅰ class Ⅱ mechanical ventilation time（t = 3.7630;P 0.01）,and high mortality（P 0.01）.Conclusion HMD had high mortality,should strengthen the perinatal care of pregnant women;alveolar active drug Curosurf（PS）can effectively improve the prognosis of HMD;birth weight than 1800g,HMD chest X-ray changed in grade Ⅰ、Ⅱ had a good clinical diagnosis and treatment prognosis,grade Ⅲ、Ⅳ was poor.