【作者】 赵玉祥；

【导师】 刘家浩；

【作者基本信息】 东南大学 ， 儿科学， 2005， 硕士

【摘要】 目的:1.探讨呼吸机治疗新生儿呼吸衰竭的效果、并发症及其相关因素。2.分析其它措施对机械通气患儿的辅助治疗作用。方法:回顾性分析2002年7月～2004年12月在我科新生儿重症监护病房(neonatal intensive care unit, NICU)行呼吸机治疗的86例呼吸衰竭新生儿资料,探讨机械通气及相关措施的应用,比较肺透明膜病(HMD)患儿治愈组与未愈组围生期因素、入院时体温、呼吸机参数、呼吸机相关性肺炎(VAP)、静脉营养天数、肺表面活性物质(PS)和盐酸氨溴索(沐舒坦)的应用等差异。结果:1.呼吸机治疗新生儿呼吸衰竭的治愈率为71%;呼吸机相关性肺炎的发生率为30.2%,肺炎克雷伯菌和铜绿假单胞菌是呼吸机相关性肺炎常见的致病菌。2.HMD治愈组与未愈组5分钟Apgar评分、呼吸机初调参数及最高参数中的吸入氧浓度(FiO2)、呼吸频率(RR)、呼气末正压(PEEP)、吸气时间(Ti)等无显著性差异(P>0.05);而胎龄、出生体重、1分钟Apgar评分、宫内窘迫、最高参数中的吸气峰压(PIP)、呼吸机相关性肺炎、静脉营养应用天数、PS和沐舒坦的应用等方面,治愈组与未愈组之间存在显著的差异(P<0.05)。3.HMD患儿PS应用组呼吸机参数最高PIP、最高FiO2及其维持时间明显低于未用组(P<0.05);HMD患儿沐舒坦治疗组与未治疗组相比,前者上机期间平均每天吸痰次数明显少于后者(P<0.05)。结论:呼吸机是治疗新生儿呼吸衰竭的主要手段,呼吸机相关性肺炎是机械通气的主要并发症。加强围生期高危因素的预防,及时防治并发症,合理使用呼吸机,同时应用PS、静脉营养和沐舒坦等辅助措施可提高新生儿呼吸衰竭的治愈率。更多还原

【Abstract】 Objective: To evaluate the effects of mechanical ventilation and other life-support procedures on neonatal respiratory failure, and to analyze corresponding complications and related high risk factors.Methods: Eighty-six neonates with respiratory failure were treated by ventilator in our NICU from July 2002 to December 2004. The application of ventilator and related remedies was explored. The differences of perinatal risk factors, temperature, ventilator parameters, incidence of ventilator associated pneumonia, use of surfactant, parenteral nutrition and mucosolvan were compared.Results: 1.The percentage of curing of critical newborn by ventilator was 71%, and the most common complication was ventilator associated pneumonia(VAP) with an incidence 30.2%. The most familiar bacterium were klebsiella pneumoniae and pseudomonoas. 2.There was no significant difference(P>0.05) in Apgar Score at 5 min, initial parameters of ventilator between the cured group and the uncured group of HMD, nor was FiO2, respiratory rate(RR), positive end-expiratory pressure(PEEP), time of inspiration(Ti) among the highest parameters. But the significant difference of the two groups was observed in gestational age, birth weight, fetal hypoxia, Apgar Score at 1 min, peak inspiratory pressure(PIP) of the highest parameter, complication with VAP, the use of surfactant, parenteral nutrition and mucosolvan(P<0.05). 3. PIP, FiO2 and duration of FiO2 among the highest parameters in surfactant treatment group of HMD were significantly lower than that of non surfactant treatment group(P<0.05). The frequency of aspirating sputum in mucosolvan treatment group of HMD was significantly less than non mucosolvan treatment group(P<0.05).Conclusions: Assisted mechanical ventilation is an important procedure in the treatment of neonatal respiratory failure. Reinforing the prognostic of perinatal high risk fators, timely prevention and treatment of complication, proper using of respirator, combined with the use of surfactant, parenteral nutrition and mucosolvan can improve the percentage of curing of respiratory failure.更多还原