手控高频持续正压通气转运新生儿重症胎粪吸入综合征

Manual high-frequency continuous positive airway pressure on the neonatal transport of severe meconi-um aspiration syndrome

目的：探讨用自动充气式复苏囊（ self-inflating bag，SIB）＋PEEP设备，手控高频持续正压通气在转运新生儿重症胎粪吸入综合征（ meconium aspiration syndrome，MAS）的临床方法及应用价值。方法在支气管肺泡灌洗、纠正酸中毒、循环支持等对症支持治疗基础上，对52例重症MAS患儿转运过程中采用SIB＋PEEP阀手控高频持续正压通气，观察病情加重、并发症发生情况，监测治疗前后不同时间的血气，并分析预后。结果52例患儿均转运成功，转运途中病情无恶化，无新增气漏、持续肺动脉高压发生，且各时间点血气 pH、PaO2、PaCO2、PaO2/FiO2均改善，差异有统计学意义（ P 〈0.01）；转运前持续肺动脉高压3例（5.77％，3/52）经转运途中加用硫酸镁等治疗病情好转；经入院后续治疗，治愈48例（92.31％，48/52），好转4例（7.69％，4/52）均合并有慢性肺疾病，但随访至出生后6个月正常。结论手控高频持续正压通气转运新生儿重型MAS方法可靠、有效、便于推广。

Objective To explore the clinic application of manual high-frequency continuous posi-tive airway pressure（ CPAP） treatment with self-inflating bags （ SIB） fitted with PEEP valves on the neonatal transport of severe meconium aspiration syndrome（ MAS） . Methods On the basis of bronchial alveolar lav-age,correction of acidosis and circulation support,52 neonates with severe MAS were treated with SIB ＋PEEP valves which were used for manual high-frequency CPAP during the transfer. The conditions,complica-tions,blood gas before and after treatment,and prognosis were monitored and analyzed. Results Fifty-two cases of MAS were transported successfully,and without any deterioration in transit condition,additional air leak,and sustained pulmonary hypertension occured. The blood gas of pH,PaO2 ,PaCO2 ,PaO2/FiO2 were im-proved at each time point,the differences were statistically significant （P〈0. 01）. Three neonates（5. 77%, 3/52） had persistent pulmonary hypertension before the treatment and were improved on the treatment with magnesium sulfate. Forty-eight cases（92. 31%,48/52）were cured,and improved in 4 cases（7. 69%,4/52） were associated with chronic lung disease,but follow-up to 6 months after birth to normal. Conclusion The method of manual high-frequency CPAP to transport the MAS neonate is reliable and effective,easy to pro-mote.