N-CPAP在早产儿RDS及新生儿呼吸衰竭中的临床应用

为探讨经鼻塞持续气道正压通气(N-CPAP)治疗早产儿呼吸窘迫综合征(RDS)及新生儿呼吸衰竭的效果,采用带有空氧混合器、加温湿化器的N-CPAP氧疗器对21例危重新生儿进行经鼻塞持续气道正压通气治疗,观察治疗前后临床症状、胸片及呼吸功能各指标的变化。结果:早产儿RDS应用N-CPAP后动脉血氧分压(PaO_2)由(42±4)升至(88±7)mmHg(P<0.01);动脉二氧化碳分压(PaCO_2)由(63.5±7.1)降至(38.2±4.9)mmHg(P<0.01);氧合指数(PaO_2/FiO_2)由(42±4)升至(420±58)mmHg(P<0.01);肺内分流量(Q_S/Q_T)由治疗初的(26.6%±3.1%)降至(5.4％±0.6%)、(1.5％±0.3％)(P<0.1)。N-CPAP治疗新生儿肺炎、先天性喉喘鸣合并呼吸衰竭及早产儿原发性呼吸暂停均有较好疗效。结果提示带空氧混合器、加温湿化器的N-CPAP治疗早产儿RDS及新生儿呼吸衰竭效果显著。是基层医院新生儿科的一种简便易行、无创安全、经济且疗效显著呼吸支持设备。     

二种无创通气模式在早产儿呼吸衰竭中的应用

目的：探讨经鼻塞持续气道正压通气(nasal continuous positive airway pressure, nCPAP)和经鼻双相正压通气(nasal biphasic positive airway pressure ventilation,nBiPAP)治疗早产儿呼吸衰竭,比较这二种模式的不同和优劣。方法81例早产儿合并呼吸衰竭需要应用呼吸支持者,分别应用nCPAP和nBiPAP模式治疗,对其无创通气和总吸氧时间、治疗失败例数、呼气末正压(PEEP)、总近期并发症发生例数以及继发感染情况等进行比较。结果 nBiPAP治疗组(n=36)患儿的平均无创通气时间为(96.34±31.5)h,总吸氧天数为(10.11±9.39)d,3例治疗失败,严重并发症发生率5.56%(2/36),PEEP(4.08±0.73)cmH2O(1cmH2O =0.098kPa);nCPAP 组(n =45)平均无创通气时间为(114.14±41.69)h,总吸氧天数为(17.53±15.96)d,15例治疗失败,严重并发症发生率15.56%(7/45),PEEP(5.11±1.01)cmH2O,两组比较差异均有统计学意义(P﹤0.05)。但在感染控制和动脉导管未闭方面,两组比较差异无统计学意义(P﹥0.05)。结论 nB iPAP可作为早产儿合并呼吸衰竭的首选治疗措施之一,明显优于nCPAP,尽早正确使用可避免有创通气。     

可变流量NCPAP加氨茶碱治疗早产儿呼吸衰竭临床观察

目的探讨可变流量经鼻持续气道正压通气（VF-NCPAP）加氨茶碱治疗早产儿呼吸衰竭的疗效。方法将NICU收治的57例呼吸衰竭，早产儿分为：治疗组（VF—NCPAP加氨茶碱静注）23例、对照组A（传统NCPAP加氨茶碱静注）18例和对照组B（单用VF—NCPAP）16例。各自进行相应治疗，比较治疗后72h内不同时间段呼吸参数改变及临床疗效。结果治疗8h后，治疗组PaO2较对照组B上升明显。有显著的差异性（P〈0．01）；治疗组PaCO2较对照组A和对照组B下降明显，治疗组OI（PaO2／FiO2）较对照组B上升明显，均有显著的差异性（P〈0．05）。治疗24h后，治疗组PaO2较对照组A上升明显，有显著的差异性（P〈0．05）。治疗48h后，治疗组FiO2较对照组A和对照组B下降明显，有显著的差异性（P〈0．05）；治疗组OI较对照组A上升明显，有显著的差异性（P〈0．01）。结论VF—NCPAP加氨茶碱治疗早产儿呼吸衰竭有较好的疗效，优于传统的NCPAP加氨茶碱或单用VF—NCPAP。     

经鼻持续气道正压治疗新生儿呼吸衰竭

目的：探讨经鼻持续气道正压气（NCPAP）治疗新生儿呼吸衰竭的疗效。方法：72例呼吸衰竭新生儿，其中1型呼衰27例，Ⅱ型呼衰45例，予NCPAP治疗，观察患儿在NCPAP前，NCPAP后4－6h,24h的临床及血气变化，比较PaO2及PaCO2的变化。结果：70例病人NCPAP后呼吸困难及缺 氧征有不同程度好转，血气PaO2明显提高（P＜0．05），PaCO2显著下降（P＜0．01），结论：NCPAP可以改善氧合和通气，对I型，Ⅱ型新生儿呼衰均有疗效。     

不同鼻塞持续气道正压通气治疗新生儿呼吸衰竭疗效分析

目的　比较不同鼻塞持续气道正压通气 (NCPAP)治疗新生儿呼吸衰竭的疗效。方法　 4 3例呼吸衰竭新生儿分成两组 ,2 6例使用新型NCPAP(InfantFlowSystem ,EME ,英国 )为nNCPAP组 ;17例使用水封瓶CPAP ,为bNCPAP组 ,比较分析两组疗效。结果　nNCPAP组、bNCPAP组成功率分别为 84 6 %、5 2 9% ;失败率 15 4 %、4 7 1% ;气胸、纵隔气肿发生率 3 8%、11 8% ;腹胀 7 7%、2 9 4 % ;治愈率 92 3%、6 4 7% ;病死率 7 7%、35 3% ;两组的成功、失败以及治愈和病死率比较均有显著性意义 (P <0 0 5 )。经NCPAP治疗两组PaO2 皆明显增加 (P <0 0 1) ,nNCPAP组比bNCPAP组差异显著 (P <0 0 5 ) ;两组均有改善通气、降低PaCO2 的作用 (P <0 0 5 ) ,但两组比较无显著意义 (P >0 0 5 )。结论　nNC PAP较bNCPAP疗效好 ,并发症少。     

可变流量NCPAP加氨茶碱治疗早产儿呼吸衰竭临床观察

目的探讨可变流量经鼻持续气道正压通气(VF-NCPAP)加氨茶碱治疗早产儿呼吸衰竭的疗效。方法将NICU收治的57例呼吸衰竭,早产儿分为:治疗组(VF-NCPAP加氨茶碱静注)23例、对照组A(传统NCPAP加氨茶碱静注)18例和对照组B(单用VF-NCPAP)16例。各自进行相应治疗,比较治疗后72 h内不同时间段呼吸参数改变及临床疗效。结果治疗8 h后,治疗组PaO2较对照组B上升明显,有显著的差异性(P<0.01);治疗组PaCO2较对照组A和对照组B下降明显,治疗组OI(PaO2/FiO2)较对照组B上升明显,均有显著的差异性(P<0.05)。治疗24 h后,治疗组PaO2较对照组A上升明显,有显著的差异性(P<0.05)。治疗48 h后,治疗组FiO2较对照组A和对照组B下降明显,有显著的差异性(P<0.05);治疗组OI较对照组A上升明显,有显著的差异性(P<0.01)。结论VF-NCPAP加氨茶碱治疗早产儿呼吸衰竭有较好的疗效,优于传统的NCPAP加氨茶碱或单用VF-NCPAP。     

经鼻持续气道正压治疗新生儿呼吸衰竭

目的　探讨经鼻持续气道正压通气 ( NCPAP)治疗新生儿呼吸衰竭的疗效。 方法　 72例呼吸衰竭新生儿 ,其中 型呼衰 2 7例 , 型呼衰 45例 ,予 NCPAP治疗 ,观察患儿在 NCPAP前、NCPAP后 4～ 6 h、2 4h的临床及血气变化 ,比较 Pa O2 及Pa CO2 的变化。 结果　 70例病人 NCPAP后呼吸困难及缺氧征有不同程度好转 ,血气 Pa O2 明显提高 ( P<0 .0 5 ) ,Pa CO2 显著下降 ( P<0 .0 1)。 结论　 NCPA P可以改善氧合和通气 ,对 型、 型新生儿呼衰均有疗效     

双管鼻塞式CPAP在早产儿肺透明膜病和新生儿呼吸衰竭中应用

目的探讨双管鼻塞式CPAP对早产儿肺透明膜病(HMD)和新生儿呼吸衰竭的治疗价值。方法对NICU住院的11例HMD和19例不同原因引起的的新生儿呼吸衰竭患儿使用双管鼻塞式CPAP进行治疗,观察治疗前后临床症状、血气指标和胸片改善情况。结果30例患儿除2例治疗无效改用气管插管机械通气外,余28例治疗前后临床症状和血气指标均有明显改善。11例HMD患儿经CPAP治疗后,除1例27周超早产儿无改善外,余10例治疗前后胸片透亮度有明显增加,治疗前后血气指标PaCO2改善较快。结论带空氧混合器和湿化的双管鼻塞式小儿CPAP系列持续正压通气系统对HMD和新生儿呼吸衰竭具有明显的治疗效果,在用氧安全和减少CO2潴留方面具优越性。     

肺表面活性物质预防早产儿RDS的临床观察

目的 探讨肺表面活性物质(PS)预防用药对预防早产儿呼吸窘迫综合征(RDS)及改善早产儿预后的可行性。方法 我院胎龄≤32W的早产儿12例,于生后预防应用PS(预防组);同期确诊为RDS 17例应用呼吸机和PS(治疗组),比例两RDS发生率、呼吸机参数、并发症及预后。结果 预防组RDS发生3例,发生率为25％,低于我院同期收治的≤32W早产儿RDS发生率(43％);预防组RDS 3例均为Ⅱ期,治疗组Ⅲ期、Ⅳ为52.9％(9/17)。预防组上呼吸机所需压力明显低于治疗组,(P<0.05);肺炎、感染、颅内出血等合并症有下降趋势;未有气漏及BPD的发生。结论 PS预防用药可降低早产儿RDS发生率及减轻发病程度,减少呼吸机的应用,减少并发症,改善早产儿预后。     

肺表面活性物质预防早产儿RDS的临床观察

目的探讨肺表面活性物质(PS)预防用药对预防早产儿呼吸窘迫综合征(RDS)及改善早产儿预后的可行性.方法我院胎龄≤32 W的早产儿12例,于生后预防应用PS(预防组);同期确诊为RDS 17例应用呼吸机和PS(治疗组),比例两RDS发生率、呼吸机参数、并发症及预后.结果预防组RDS发生3例,发生率为25%,低于我院同期收治的≤32 W早产儿RDS发生率(43%);预防组RDS 3例均为Ⅱ期,治疗组Ⅲ期、Ⅳ为52.9%(9/17).预防组上呼吸机所需压力明显低于治疗组,(P＜0.05);肺炎、感染、颅内出血等合并症有下降趋势;未有气漏及BPD的发生.结论 PS预防用药可降低早产儿RDS发生率及减轻发病程度,减少呼吸机的应用,减少并发症,改善早产儿预后.     

MILK FAT BOLUS OBSTRUCTION IN A PRETERM INFANT

ABSTRACT. We describe a preterm infant who developed an intestinal fat bolus obstruction on the 18th day of life. Shortly before the obstruction the infant's feeding had been changed from maternal breast milk to a special formula for preterm infants. Although the fatty acid composition of the bolus resembled breast milk more than the formula, the abrupt change in the feed may have caused the formation of the bolus.     

RICKETS IN A PRETERM INFANT DURING INTRAVENOUS ALIMENTATION

ABSTRACT. A preterm baby given intravenous feeding developed severe rickets. Laboratory investigation revealed hypophosphatemia as the main cause of this picture. Recovery was achieved by giving extra phosphorus supplementation. This case demonstrates that conventional infusates do not meet the phosphorus requirement of rapidly growing infants.     

RESPIRATORY INSUFFICIENCY SYNDROME (RIS) IN PRETERM INFANTS WITH GESTATIONAL AGE OF 32 WEEKS AND LESS

ABSTRACT: Carlsson, J. and Svenningsen, N. W. (Department of Paediatrics, University Hospital, Lund, Sweden). Respiratory insufficiency syndrome (RIS) in preterm infants with gestational age of 32 weeks and less. Neonatal management and follow-up study. Acta Paediatr Scand, 64: 813, 1975.–The clinical entity of respiratory insufficiency syndrome (RIS), i.e. irregular breathing leading to recurrent apnea and bradycardia in an otherwise healthy preterm infant, has been studied in respect of symptomathology and management with intensive case including ventilatory support. During a 4-year period 26 of 103 infants with gestational age 32 weeks and mean birth weight 1304 g (range 710 to 1830 g) developed RIS. In most infants the initial apnea occurred after 2 and before 72 hours post delivery but in some infants later. Because of progressive hypoxemia and acidosis IS of the 26 RIS infants required IPPV treatment. The 76 % survival rate of RIS infants seems to justify intensive care with ventilatory support even in the smallest preterm infants with RIS, especially as the follow-up study performed at 15 months to 3 ½ years of age showed neurological sequelae in only 3 of 20 surviving babies, i.e. 15 % sequelae rate.     

CLINICAL ASSESSMENT OF GESTATIONAL AGE IN THE NEWBORN INFANT

ABSTRACT. Vogt, H., Haneberg, B., Finne, P. H. and Stensberg, A. (Department of Paediatrics, University of Bergen, and Department of Clinical Chemistry, Akershus Central Hospital, University of Oslo, Norway). Clinical assessment of gestational age in the newborn infant. An evaluation of two methods. Acta Paediatr Scand, 70:669,.–The scoring systems of Dubowitz et al. and Parkin et al. were evaluated in two selected materials of newborn infants referred to a neonatal unit. Our estimation of gestational age by Dubowitz scores tended to be too high for the extreme prematures. "Small-for-dates" were also overestimated, whilst "appropriate-for-dates" and infants with respiratory difficulties were underestimated. "Large-for-dates" fell close to the standard curve. Ninety-five per cent confidence limits were up to ±5 weeks for Dubowitz scores and nearly ±6 weeks for Parkin scores. Further statistical analysis displayed some limitations in the use of linear regression formulas for scoring systems based on external and/or neurological characteristics. Thus, the results obtained with these methods must be used with caution in some selected newborn materials.     

RETICULAR DYSGENESIS IN A PRETERM INFANT: A Case Report

Reticular dysgenesis (RD) is a rare congenital immunodeficiency classified within the severe combined immunodeficiencies (SCIDs) and characterized by impairment of both lymphoid and myeloid cell development. Neutropenia unresponsive to recombinant human granulocyte colony-stimulating factor (rGCSF) is the hallmark of RD and the clinical course is rapidly fatal due to overwhelming infections. The authors report a female newborn at 32 weeks of gestation presenting with severe leukopenia at birth. The bone marrow showed a maturation arrest in the myeloid and lymphoid lineage. She had no response to granulocyte colony stimulating factor (rGCSF) treatment and died with sepsis at age of 2 months.