气管插管冲洗治疗胎粪吸入综合征44例

目的观察气管插管冲洗治疗胎粪吸入综合征40例的临床疗效。方法回顾分析胎粪吸入综合征（MAS）79例。其中气管插管冲洗40例为治疗组;无气道插管冲洗39例为对照组。观察两组的疗效。治疗组除在头及全身娩出后各进行一次口、鼻、咽部清吸外,要在15-20s内完成清吸、刺激、供氧等措施。后治疗组予以气管插管用0.5ml生理盐水反复冲洗至液体变清为止。结果①血气分析中：两组在0-3h的各项数值无显著性差异;但在4-24h的数值（除pH、PCO2外）PO2、Pao2a/A之间均有显著性差异（P〈0.05）。②治疗组较对照组在治愈率、上机人数率、合并症率、死亡率的比较有显著性差异（P〈0.05）。③治疗组较对照组可缩短治愈患儿住院天数,两组之间有显著性差异（P〈0.05）。结论对有粘稠胎粪、合并窒息、产前有导致窒息的高危因素的胎儿于吸净气管内分泌物后立即气管插管予以气道冲洗,可以减少胎粪吸入综合征的发生率。     

胎粪性腹膜炎合并肠闭锁新生儿产前超声征象及其预后

目的探讨胎粪性腹膜炎合并肠闭锁产前超声征象与新生儿临床结局的相关性。方法回顾从2008年2月至2014年6月生后于我院手术证实胎粪性腹膜炎合并肠闭锁病例42例。就手术方式分为2组:A组肠吻合组,B组肠造瘘组。比较两组患儿产前超声征象差异、产后临床特点。结果全部患儿均为产前B超怀疑复杂性胎粪性腹膜炎,A组24例,B组患儿18例。B超征象包括钙化30例次,羊水过多17例次,腹水17例次,肠管扩张39例次,假性囊肿6例次。产前末次超声结果:A组患儿肠管扩张24例,少量腹水5例,羊水过多10例,钙化18例,中大量腹水0例,巨大假性囊肿0例;B组肠管扩张9例,少量腹水2例,羊水过多7例,钙化12例,中大量腹水7例,巨大假性囊肿4例。结论早期诊断对于胎粪性腹膜炎合并肠闭锁尤为重要,有助于提高整体治疗效果及预后。产前超声征象能预测新生儿预后及手术风险。     

机械通气在胎粪吸入综合症的应用

目的　探讨机械通气在胎粪吸入综合症 (MAS)致呼吸呼衰的临床应用价值 .方法　对具有机械通气指征的 2 6例MAS新生儿时行回顾性分析 .结果　机械通气后PH值改善 ,动脉氧分压 (PO2 )升高 ,二氧化碳分压 (PCO2 )下降 ,低氧血症和高碳酸血症改善 (p <0 .0 1) ;根据血气和胸片结果选择不同通气参数 ,可避免发生气压伤 .结论　合理的通气参数下的机械通气 ,可以改善MAS低氧血症和高碳酸血症     

胎肩娩出前吸净口咽及鼻部污染羊水及胎粪预防胎粪吸入综合征的效果观察

目的 探讨胎肩娩出前立即吸净口咽及鼻部污染羊水及胎粪,预防胎粪吸入综合征的效果.方法 将新生儿随机分为两组.对照组在胎儿娩出后吸净口咽及鼻部污染羊水及胎粪,干预组在胎肩娩出前立即吸净口咽及鼻部污染羊水及胎粪,观察两组新生儿胎粪吸入综合征的发生率.结果 对照组发生胎粪吸入综合征8例(6.35%),干预组发生3例(2.22%),两组比较有显著性差异(P<0.05).结论 新生儿胎肩娩出前吸净口咽及鼻部污染羊水及胎粪,对预防胎粪吸入综合征的发生具有明显效果.     

机械通气在胎粪吸入综合症的应用

目的探讨机械通气在胎粪吸入综合症(MAS)致呼吸呼衰的临床应用价值.方法对具有机械通气指征的26例MAS新生儿时行回顾性分析.结果机械通气后PH值改善,动脉氧分压(PO2)升高,二氧化碳分压(PCO2)下降,低氧血症和高碳酸血症改善(p<0.01);根据血气和胸片结果选择不同通气参数,可避免发生气压伤.结论合理的通气参数下的机械通气,可以改善MAS低氧血症和高碳酸血症.     

一氧化氮吸入和重组人超氧化物歧化酶对胎粪吸入肺损伤后肺组织纤维化指标的观察

目的：观察一氧化氮(NO)吸入和重组人超氧化物歧化酶(rhSOD)气管内给药对胎粪吸入肺损伤时肺转化生长因子β1(TGF-β1)和羟脯氨酸的变化,以了解其对胎粪吸入肺损伤后组织修复的影响。方法: 40只雄性SD幼年大鼠，随机分为：(1)对照组（control，C）：气管置管注入1 mL/kg生理盐水，暴露于空气中；（2）胎粪吸入组(Mec)：气管置管注入20%胎粪1 mL/kg,暴露于空气中；(3)NO吸入组（iNO）：胎粪注入后暴露于20×10-6 NO中；（4）rhSOD组（SOD）：胎粪注入后，rhSOD 20 mg/kg气管内注入并暴露于空气中；（5）联合应用20×10-6 NO和20 mg/kg rhSOD组（iNO/SOD）。用RT-PCR方法测定肺组织TGF-β1 mRNA含量，用羟脯氨酸测试盒测定肺组织羟脯氨酸含量。结果: 胎粪吸入组肺组织TGF-β1 mRNA含量明显高于正常组（1.315±0.394 vs 0.676±0.166，P＜0.05），NO吸入、rhSOD及iNO/rhSOD治疗组TGF-β1 mRNA含量明显低于胎粪吸入组（0.694±0.187 vs 1.315±0.394， 0.758±0.331 vs 1.315±0.394, 0.566±0.370 vs 1.315±0.394， 均P＜0.05），iNO和rhSOD未见协同作用。各组羟脯氨酸含量未见显著差异。结论： NO吸入和rhSOD气管给药能降低胎粪吸入肺损伤时肺组织TGF-β1 mRNA 含量，提示这两种治疗方法对胎粪吸入肺损伤后组织纤维化可能具有抑制作用。     

肺表面活性物质治疗重症新生儿胎粪吸入综合症

目的探讨肺表面活性物质(PS)治疗重症胎粪吸入综合症(MAS)的疗效.方法对8例重症MAS常规机械通气下,气管内滴入PS,比较用药前后的临床表现、血气分析结果、肺功能变化和并发症的发生.结果 8例给药后紫绀改善,吸气呼吸困难减轻,2h内动脉血氧分压由5.6±1.0kPa升高至9.5±1.2kPa,动脉血二氧化碳分压由7.43±1.56kPa降至6.65±1.44kPa,氧合指数由8.15±1.4升至16.7±5.4.7例MAS患儿治愈,1例自动出院.结论 PS治疗重症MAS疗效肯定,值得临床推广.     

肺表面活性物质治疗重症新生儿胎粪吸入综合症

目的　探讨肺表面活性物质 (PS)治疗重症胎粪吸入综合症 (MAS)的疗效 .方法　对 8例重症MAS常规机械通气下 ,气管内滴入PS ,比较用药前后的临床表现、血气分析结果、肺功能变化和并发症的发生 .结果　 8例给药后紫绀改善 ,吸气呼吸困难减轻 ,2h内动脉血氧分压由 5.6± 1.0kPa升高至 9.5± 1.2kPa ,动脉血二氧化碳分压由 7.43±1.56kPa降至 6.65± 1.44kPa ,氧合指数由 8.15± 1.4升至 16.7± 5.4.7例MAS患儿治愈 ,1例自动出院 .结论　PS治疗重症MAS疗效肯定 ,值得临床推广     

扬州地区新生儿气胸58例临床分析

目的探讨新生儿气胸的病因、临床表现及防治。方法总结2005年1月～2008年5月收住我院新生儿科的58例气胸患儿资料,其中保守治疗24例,一次性胸腔穿刺抽气7例,静脉留置针穿刺闭式引流22例,胸腔切开闭式引流5例。结果治愈44例,好转6例,放弃治疗自动出院6例,死亡2例。其中,保守治疗24例全部治愈,3例因经济原因自动出院。结论新生儿气胸主要与窒息、胎粪吸入及医源性因素有关,减少胎粪吸入,降低窒息发生率,正确复苏,合理应用呼吸机,选择正确的分娩方式可减少气胸的发生率。     

新生儿吸入性肺炎的护理

新生儿吸人性肺炎是早期新生儿的常见病,多发病之一,也是新生儿死亡率较高的疾病之一,常合并多脏器功能不全,按病因分为羊水吸入,胎粪吸入和乳汁分泌物吸入3种,其中胎粪吸入性肺炎最重,我院自2005年1月-2006年8月共收治27例新生儿吸入性肺炎患儿,现将护理报告介绍如下。临床资料1.一般资料:27例新生儿吸入性肺炎患儿中男性17人,女性10人,均在出生后1w内发病,入院时日龄最小的30m in,最大的6d,出生时均有不同程度的窒息史。2.临床诊断:根据病史,体格检查,X光及病原学检查等,确诊为羊水吸入性肺炎19例,胎粪吸入性肺炎的6例,乳汁或分泌物吸入性肺炎2例。3.结果:经治疗和护理27例患儿中,治愈26例,因呼吸衰竭死亡1例。护理与讨论1.一般护理:患儿入科后因有患儿全身皮肤被胎粪污染,皮肤极易发生感染,因此应保持皮肤清洁,可先用石蜡油棉球将皮肤轻轻擦拭干净,再用温开水擦干,将患儿置于远红外辐射台,根据体重、月龄给予中性温度,因患儿体温调节中枢发育未完善体表面积相对较大,皮肤面积较易散热,高热主要靠棕色脂肪化学产热,但均需氧的参与,窒息和肺部炎症均可导致缺氧,使产热不定,体重不升,加上不能进食,使能量供给不...     

Anti-inflammatory treatment of meconium aspiration syndrome: Benefits and risks

Meconium aspiration syndrome (MAS) is a major cause of respiratory insufficiency in the term and post-term newborns. There are several pathomechanisms participating in this disorder, particularly the airway obstruction, surfactant dysfunction, inflammation, lung edema, pulmonary vasoconstriction and bronchoconstriction. Inflammatory changes resulting from meconium aspiration cause severe impairment of lung parenchyma and surfactant, and influence the reactivity of both vascular and airway smooth muscle. Therefore, anti-inflammatory drugs may be of benefit in the management of MAS. This article reviews the pharmacological actions and side effects of various anti-inflammatory drugs used up to now in the experimental models of MAS and in the treatment of newborns with meconium aspiration.     

新型鼻塞持续气道正压治疗新生儿低氧血症疗效分析

目的回顾性的研究新型鼻塞持续气道正压(nCPAP)治疗新生儿严重低氧血症的疗效及安全性。方法以常规给氧无效的83例严重低氧血症患儿为研究对象,其中足月儿32例,早产儿51例。呼吸暂停33例,肺炎并呼吸衰竭(呼衰)21例,肺透明膜病19例,胎粪吸入综合征6例,新生儿湿肺4例。给予使用新型nCPAP治疗,观察治疗效果、并发症发生情况。结果给予nCPAP治疗后绝大多数患儿缺氧状态得到改善。治愈67例,16例效果不好转为气管插管行其他模式机械通气治疗。腹胀8例,心功能不全5例,鼻前庭皮肤部压迫伤2例,无一例发生气漏、慢性肺疾病和早产儿视网膜病。结论新型nCPAP治疗新生儿严重低氧血症操作方便,疗效满意,可以很好的控制温度和吸入氧的浓度,避免了因吸入纯氧、高浓度氧引起的视网膜病、慢性肺疾病等氧中毒性损伤。减少了气管插管的机会,降低了呼吸机相关性肺炎的发生率,相对比较安全。     

In vitro effect of meconium on the physical surface properties and morphology of exogenous pulmonary surfactant.

The pathophysiology of meconium aspiration syndrome(MAS) is related to mechanical obstruction of the airways and to chemical pneumonitis. Meconium is also suggested to cause functional deterioration of pulmonary surfactant. Recent studies have reported that meconium inhibits the physical surface properties of pulmonary surfactant, and that administration of exogenous surfactant may provide therapeutic benefits in animal models or infants with respiratory distress due to MAS. To assess the effects of meconium on physical surface properties, especially the changes on the air-liquid interface and hypophase of pulmonary surfactant in vitro, we studied the following findings; a) the surface spreading rate(SSR) and the surface adsorption rate(SAR), b) the viscosity, c) the electron microscopic changes, on a series of mixtures with various concentrations of lyophilized human meconium and Surfactant-TA(SurfactenTM). The human meconium has significantly increased the surface tension of SSR and the viscosity of pulmonary surfactant, but had decreased the surface pressure of SAR of surfactant, and changed the electron microscopic findings of surfactant. We have concluded that these findings support the concept that meconium-induced surfactant dysfunction may play a role in the pathophysiology of MAS.     

The pulmonary vasculature in meconium aspiration

Some studies have suggested that pulmonary hypertension in the newborn with meconium aspiration can be attributed to a primary prenatal increase in pulmonary arterial musculature; but this concept has been controversial. To examine this question, we reviewed 62 infants autopsied at The Johns Hopkins Hospital, 24 of whom demonstrated meconium aspiration, 20 with meconium staining but no aspiration, and 18 with abruptio placentae without meconium aspiration or staining. Clinical and pathologic features were evaluated and cross-sectional arterial medial area was determined at the junction of the conducting and respiratory airways in nondistended lungs. No significant difference in arterial medial area was found between infants with meconium aspiration and those with meconium staining only or abruptio placentae. In addition, circumferentially muscularized intraacinar arteries were present in all infants with meconium aspiration and abruptio placentae, and all but one infant with meconium staining alone. Comparison of lungs with and without arterial injection and fixation in distention showed that injection does not uniformly distend vessels and that formalin distention may remove or mask meconium. The study suggests that meconium aspiration and its complications, not primary structural arterial changes, account for pulmonary hypertension in infants with meconium aspiration.     

部宫产早期新生儿死亡原因分析

目的：探讨剖宫产分娩早期新生儿死亡的原因及相关因素。方法：分析45例剖宫产早期新生儿死亡的尸体检查和临床资料,按临床及病理诊断评价死因,并了解各相关因素构成。结果：剖宫产早期新生儿死亡占同期新生儿死亡的58．44％;早产儿、低出生体重儿是剖宫产早期新生儿死亡的主要因素。各项死因构成分别为：早产儿占42．22％,羊水吸入综合征占13．33％,胎粪吸入综合短占11．11％,窒息占11．11％,畸胎占11．11％,其它占11．11％。死亡新生儿中不存在性别差异（P＞0．05）。结论：剖宫产不是降低新生儿死亡率的唯一手段;加强高危妊娠管理,提高新生儿救治效果是降低新生儿死亡率的重要措施。     

Meconium aspiration syndrome treatment - new approaches using old drugs

Presently, modern medicine does not offer any disease-modifying treatment for meconium aspiration syndrome (MAS). Several medications with already established safety profiles when employed for similar or other conditions could be useful for MAS treatment. N-Acetylcysteine and DNAse have the capability to reduce viscosity and thickness of meconium by breaking disulfide bonds and slicing DNA, respectively. N-Acetylcysteine, antiprotease drugs, or low pH buffer solutions may have the capability to neutralize meconium's digestive enzymes responsible for lung damage in patients with MAS. All these compounds have great potential to reduce meconium's pathogenic properties which in turn could alleviate MAS severity.     

Classification of acute respiratory disorders of all newborns in a tertiary care center

OBJECTIVE: To assess the usefulness of current diagnostic criteria in the understanding of neonatal respiratory distress in a tertiary care hospital. METHODS: We prospectively studied 2824 consecutive deliveries to determine the frequency of respiratory disorders of all types. We used definitions based on standard texts, with borderline cases being classified as having the disease in question. RESULTS: Somewhat less than half of all symptomatic infants met textbook criteria for a respiratory diagnosis. Of this subset, the most common diagnosis was respiratory distress syndrome (RDS), followed by transient tachypnea of newborn (TTN), meconium aspiration syndrome (MAS), pneumonia and others. The 323 infants who fit no standard diagnosis all had self-limited conditions similar to TTN. Most (52%) were well in less than 12 hours. Those still symptomatic after 12 hours differed from the definition of TTN by having a clear chest film (38%) and/or by requiring mechanical ventilation (10%). A slight revision of the traditional diagnostic criteria allowed classification of all these cases. CONCLUSION: More than 50% of newborns with acute respiratory symptoms do not fit textbook definitions, even broad definitions which include borderline cases. The concept of TTN should be expanded to include cases with a normal chest film. In addition, we suggest adding the category "transient respiratory insufficiency of the newbom" (TRIN) for babies ventilated briefly but not demonstrably surfactant deficient or infected. This category probably includes infants with many contributing etiologies.     

How to overcome surfactant dysfunction in meconium aspiration syndrome?

Surfactant dysfunction in meconium aspiration syndrome (MAS) is caused by meconium components, by plasma proteins leaking through the injured alveolocapillary membrane and by substances originated in meconium-induced inflammation. Surfactant inactivation in MAS may be diminished by several ways. Firstly, aspirated meconium should be removed from the lungs to decrease concentrations of meconium inhibitors coming into the contact with surfactant in the alveolar compartment. Once the endogenous surfactant becomes inactivated, components of surfactant should be substituted by exogenous surfactant at a sufficient dose, and surfactant administration should be repeated, if oxygenation remains compromised. To delay the inactivation by inhibitors, exogenous surfactants may be enriched with surfactant proteins, phospholipids, or other substances such as polymers. Finally, to diminish an adverse action of products of meconium-induced inflammation on both endogenous and exogenously delivered surfactant, anti-inflammatory drugs may be administered. A combined therapeutic approach may result in better outcome in patients with MAS and in lower costs of treatment.     

深圳地区羊水过少226例临床分析

目的探讨羊水过少与妊娠并发症的关系及其分娩方式的选择与围生儿预后关系。方法收集我院2005年6月至2006年5月住院分娩的羊水过少孕妇226例,随机抽取我院同期分娩的羊水量正常孕妇220例为对照组,两组病例就妊娠并发症、分娩方式及围生儿情况进行比较。结果羊水过少组中过期妊娠、妊娠期高血压疾病、胎儿生长受限（FGR）及胎儿畸形的发生率均高于对照组（P〈0.01）。羊水过少组羊水粪染、胎儿窘迫、胎粪吸入综合征（MAS）的发生率明显高于对照组（P〈0.05,P〈0.01）。羊水过少伴妊娠并发症组羊水粪染、胎儿窘迫、新生儿窒息的发生率明显高于无并发症组,（P〈0.01,P〈0.05）,剖宫产率明显增加（P〈0.01）,而胎粪吸入综合征（MAS）与围生儿死亡率无显著差异（P〉0.05）。单纯羊水过少者围生儿结局与对照组无显著差异（P〉0.05）。结论羊水过少与妊娠并发症密切相关,羊水过少伴有妊娠并发症者围生儿结局不良,应放宽手术指征,单纯羊水过少者可以阴道试产。     

The causes of morbidity and mortality among infants born at term

Previous studies have reported on the pathologic spectrum of perinatal mortality; however, in our opinion, the problems pertaining to the term newborn have not been emphasized sufficiently. We reviewed the autopsies of all term infants up to 2 months of age in a ten-year period (July 1975 to July 1985). These 342 patients comprised 20% of all pediatric autopsies. The patients were grouped according to cause of death in the following categories: congenital anomalies (59%); infection (10%); perinatal injury, including meconium aspiration (9%); maternal-placental problems (11%); and miscellaneous (5%). In 4% of the cases, mainly stillbirths, the cause of death was unclear. Of the congenital anomalies, the cardiovascular system was most affected (57%). Hyaline membrane disease and intraventricular hemorrhage, usually frequent in series involving many preterm patients, were seldom seen. This study emphasizes the different pathologic spectrum of mortality between premature and term newborns.