新生儿呼吸衰竭的呼吸机治疗

Application of Respirator to the Treament of Neonatal Respiratory failure

目的 :分析呼吸机治疗新生儿呼吸衰竭的疗效、并发症及相关因素。方法 :总结 2 0 0 0年 7月～ 2 0 0 2年 12月在我科NICU呼吸机治疗的 6 3例新生儿资料 ,分析其各种并发症的相关因素 ,比较肺透明膜病 (HMD)治愈组与死亡组胎龄、出生体重及上机日龄的差异。结果 :呼吸机治疗新生儿呼吸衰竭的治愈率为 6 9.8% ;机械通气过程中呼吸机相关肺炎的发生率为5 3.0 % ,其中下呼吸道分泌物培养的阳性率为 4 1.3% ,葡萄球菌、铜绿假单胞菌、肺炎克雷伯菌为常见的致病菌 ;气漏、肺不胀的发生率分别为 12 .7%、7.9% ,肺气漏的发生与吸气峰压、呼气末正压明显相关 ;HMD患儿治愈组与死亡的组胎龄、出生体重、上机日龄比较有显著差异 ;治愈的HMD患儿支气管肺发育不良的发生率为 2 5 .9% ,BPD的发生与胎龄、体重明显相关。结论 :呼吸机是治疗呼吸衰竭的主要手段 ;下呼吸道感染是机械通气的主要并发症 ;建议早产儿当吸气峰压超过 2 5cmH2 O时 ,使用高频通气以免发生肺气压伤 ;HMD患儿胎龄越小 ,体重越低 ,病情越重 ,病死率越高 ,同时也越易并发BPD。

Objective: To analysis the effects and complication of the treatment of neonatal respiratory failure by respirator. Methods:Sixty-three newborn infant with respiratory failure were treated by respirator in NICU between July ,2000 to October ,2002 . the result, complication and the related factors were analyzed. the difference of gestational age ,birth-weight ,the age of using respirator between the cure group and the death group was compared. Results:The percentage of curing of neonatal respiratory failure by respirator was 69.8%.The incidence of ventilator-associated pneumonia was 50.0%,the positive percentage of colonizing bacteria in low respiratory tract in patient with mechanical ventilation was 41.3%.The most familiar bacterium were staphylococcosis, pseudomonoas,klebsiella pneumoniae. The incidence of air leak, atelectasis was separately 12.7%,7.9%. air leak was positive related to PIP,PEEP. The gestational age, birth-weight, the age of using respirator between the cure group and the death group was markedly different. The incidence of bronchial pulmonary dysplasia(BPD) to cured HMD was 25.9% and BPD was obviously related to gestational age, birth-weight.Conclusion:The application of respirator improve the percentage of curing of respiratory failure. Lower respiratory tract infection is the main complication. It is recommend that high frequency ventilator is used to avoid air leak when PIP is above 25 cmH 2 O. The more younger and the more lighter ,the HMD will be more serious , and mortality rate will be more higher. Simultaneity, BPD will be more easily happened .