【摘要】 目的分析呼吸机治疗新生儿肺透明膜病(HMD)的疗效及影响预后的因素。方法对2000年1月~2002年12月在我科NICU呼吸机治疗的54例HMD患儿进行总结,分析其疗效,比较治愈组与病死组胎龄、出生体重、上机日龄、上机前血气及吸气峰压(PIP)、呼吸未正压(PEEP)、各种并发症的差异。结果呼吸机治疗新生儿HMD的治愈率为68.4％;病死组胎龄、出生体重均明显低于治愈组(P<0.05),病死组上机时的日龄及上机前的血pH值均明显小于治愈组(P<0.01),病死组呼吸机参数PIP、PEEP均明显高于治愈组(P<0.05),两组间各种并发症的比较差异无显著性。结论呼吸机是治疗新生儿HMD的主要手段;HMD患儿胎龄越小,体重越低,则病变发生越早,上机前酸中毒越明显,病死率就越高。更多还原

【Abstract】 Objective Despite a significant improvement in overall survival rate of neonatal hyaline membrane disease (HMD) has been achieved since the establishment of the NICU and the advances in the treatment of mechanical ventilation in infants with respiratory distress syndrome(RDS), neonatal RDS remains a major cause of mortality in immature infants. The objective of this study was to evaluate the impact of the mechanical ventilation therapy for neonatal HMD and factors associated with its prognosis. Methods Fifty-four newborn infants(34 male and 20 female)with HMD who received treatment of ventilator from our NICU were analyzed between Jan 2000 to Dec 2002(mean gestational age:31 weeks;mean birth weight: 1598 g, including 27 of them weighing below 1500 g) . There were 37 successes, 11 deaths and 1 quit among those who required mechanical ventilation. Comparisons of difference were made between the group of success and the group of death regarding the gestational age, birth weight, the age at receiving the treatment(hour), pH levels before the treatment, PIP, PEEP, FiO2 of the ventilator and various complications. Results The successful rate was 68.4% for infants who received mechanical ventilation. Both the gestational age(mean: 29.5±2.4 weeks) and the birth weight(mean: 1352±202 g) of the death group were smaller than those (mean: 31.1±2. 0 weeks, mean: 1644±427 g) of the success group(P<0. 05) . There were a significant reduction in the age at receiving the treatment( mean: 3. 4±2.6 hour) and the pH levels before treatment (mean: 7.099±0.162) (P<0.01) in the death group than those of the success group (mean: 10. 6±11. 1 hour, mean: 7.273±0.09) .The parameters of ventilator were significantly higher in the death group(PIP: 24. 7±4.0cmH2O, PEEP: 5. 7±1. 3 cmH2O) than those the success group(PIP: 22.3±3.2cmH2O, PEEP: 4. 8±1. 3 cmH2O)(P<0. 05). There was no difference in the incidence of asphyxia at birth, pneumothorax, atelectasis, pulmonary hemorrage, intraventricular hemorrhage, arhythmia, DIC, NEC between two groups. Conclusions Mechanical ventilation played an important role in the treatment of neonatal HMD.Many factors including gestational age, birth weight, age at receiving the treatment, the pH levels before treatment and the pressure of mechanical ventilation will have an impact on the outcomes of the disease. A variety of insults may contribute to the mortality rate of infants, which include the lower gestational age and birth weight, the early onset and the severity of the acidosis before mechanical ventilation. No significant correlations were noted between the existence of asphyxia or other complications and the outcomes.更多还原